Population Health Initiatives Could Include Focus on Spiritual Care
By Melinda Young
Spiritual care can be separated from the chaplain experience and focus on patients across the continuum, the author of a new paper suggests.1
Integrating spiritual care into outpatient, managed care, and population health can enhance patient care and improve the effectiveness of interdisciplinary teams.
“The purpose of the paper is to share with a broader audience the experience we’ve had of bringing spiritual care out of the hospital, and instead of being focused on the institution, rather to think about the focus of care being the patient,” says Charles Valenti-Hein, MDiv, PhD, a chaplain specialist with the Ascension on Demand Spiritual Care Team of Ascension Health in St. Louis.
An Ascension remote care team provided additional support to patients with complex care needs after discharge. At first, the remote care team focused on medical care, with a social worker also addressing social determinants of health, Valenti-Hein says.
The organization’s mission recognizes the spiritual and emotional aspects of healing, so it was a natural evolution to bring spiritual care into the remote care team’s practice.
“The real objective was to fully include spiritual care within a larger care management team and multidisciplinary team,” he explains.
The teams now consist of three people, including a nurse case manager, a behavioral case manager, and a board-certified chaplain with a master’s degree.
“We’re trained to work with people within their spiritual and religious backgrounds or without [a religious background],” Valenti-Hein says. “We have the ability to work with people regardless of their religious or spiritual identity, or lack of it.”
The team also can consult pharmacists. The remote care team focuses on diabetes management, COPD, chronic heart failure, and hypertension. “We’ve also incorporated postoperative joint replacement,” Valenti-Hein adds. “It seems to work well because hospitalization for joint replacements have gotten so short.”
Joint replacement patients may question what their symptoms of physical pain mean to them and how it affects understanding themselves as a functional human, which is the spiritual aspect, Valenti-Hein explains. The team can address those concerns with patients after they are discharged. “When they are home and in rehab, we can do a chaplain check-in and say, ‘The knee is coming along well, and the physical therapist is satisfied with the progress you’re making. But how are you coping with everything you’ve been through?’” Valenti-Hein says. “That’s a strong contribution to patients’ overall health.”
The remote care team started its work before the COVID-19 pandemic. “Interestingly, many of the tools or modalities of care we were identifying, especially with remote care, we discovered within the pandemic,” Valenti-Hein notes. “These were helpful with meeting patients’ spiritual needs within acute care settings, via telephone, or using Skype or video.”
When the inpatient setting returned to the pre-pandemic practice of allowing various members of the care team into patients’ rooms, the remote care team continued to incorporate spiritual care in its work, focusing on patients after discharge. The team reached more patients through remote technology, rather than scheduling home visits. The pandemic made remote technology more accessible to patients, who had grown to accept the practice.
“It is not only acceptable, but people find good value in spiritual care delivered in these virtual models,” Valenti-Hein says.
One example is the case of an older man who experienced health difficulties and was enrolled in the Medicare Advantage program. “His wife had a fairly significant medical problem,” Valenti-Hein recalls. “At the beginning of care for him, he was living separated from his wife while she was recovering in a nursing home.”
The man expressed many concerns. His No. 1 problem was incontinence and bladder control. “He didn’t want to go out anymore, even though he was a social person,” Valenti-Hein says. “The chaplain came along and was able to talk about what that means for him.”
As a proud man who had led a successful life, he found the problem infantilizing. He struggled with his self-image and confronting his own mortality.
“The things he wanted to do with his life, and who would pick up the work he was doing when he was no longer able to — all of this compounded with the fact he was unable to share a home with the wife he had lived with for 40 to 50 years,” Valenti-Heil says.
As the chaplain helped the man with his spiritual needs, the other health issues improved. “The most obvious one was the way in which spiritual care had an impact on his mental and behavioral health,” Valenti-Hein says.
Spiritual care for the elderly and for patients in dementia care means the case manager honors the patient’s story. The chaplain listened as the patient talked about his academic career and achievements.
“Honoring his narrative gave him the opportunity to bring some sense of closure and peace at what the future would hold for him,” Valenti-Heil explains. “Spiritual care intervention is saying you may not be able to do all those things anymore, but what are you able to do that gives you great pleasure.”
In this case, one of the man’s pleasures was porch gardening. Growing tomato plants and vegetables on his porch gave him a deep sense of meaning, even as his health was declining.
“The other interesting factor in his case is at the beginning, he and his son were disaffected from each other, partly because he had been so successful in his academic career that his son never thought he held enough light to his father’s glory,” Valenti-Hein says. “But with porch gardening, his son found something he could do in a meaningful way with his father, and they bonded over it.”
The chaplain had facilitated this connection, partially by helping the patient embed his story within a broader narrative.
“Patients let us see them as more than the illness that got them to the point of care management, and we share that story with the care team,” Valenti-Heil says. “One of the greatest advantages to having a chaplain on the team is the other members can see the patient contextualized in a broader life, so they’re no longer the diabetes patient.”
REFERENCE
- Valenti-Hein C. Integrating spiritual care in population health and care management: Two case examples. Prof Case Manag 2022;27:229-238.
Spiritual care can be separated from the chaplain experience and focus on patients across the continuum, the author of a new paper suggests. Integrating spiritual care into outpatient, managed care, and population health can enhance patient care and improve the effectiveness of interdisciplinary teams.
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