Welcome to the Phoenix Area Interactive Learning Session

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Welcome to the Phoenix Area Interactive Learning
Session
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Spiritual Care within an IHS Clinical Care Setting
Donice Hoopaugh, MSN/MHA, CCM , RN
donice.hoopaugh_at_ihs.gov Cathy Witte, RPh, MDiv,
MS Bioethics catherine.witte_at_ihs.gov
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Spiritual Care in Healthcare

• Supported by the Indian Health Service mission to
  raise the physical, mental, social, and spiritual
  health of American Indians and Alaska Natives to
  the highest level.
• Recognized by The Joint Commission and CMS

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AI/AN Statistics/Demographics (US Census Bureau)

• Over 350 tribes in the United States, many have
  relocated to our area. American Indians and
  Alaska Natives speak more than 250 languages.
  Some live on rural or remote reservations, in
  villages and pueblos, and on Rancherias and
  tribal trust lands but according to the census
  2000 the majority (66 ) live in urban areas. 1
• 36 (684,000/1.9 million of the IHS service area
  population resides in non- Indian areas, and
  600,000 ARE SERVED IN URBAN CLINICS. 1
• 1) U.S. Census Bureau 2010

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Phoenix Indian Medical Center
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22 federally recognized Arizona tribes
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CULTURAL CONTINUUM

• URBANIZED
• English speaking only
• No tribal ties
• Full acculturation into non-Native society

• TRADITIONAL
• Non-English speaking
• Close-knit family
• Minimal involvement with non-Native society

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• Diversity of spiritual needs and expressions

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Chaplaincy and Traditional Care at PIMC

• Diverse faith and tribal affiliations
• Traditional practitioners and chaplains available
  when services are requested for prayer.
• If request is for specific tribal practitioner or
  religious representative, PIMC will attempt to
  assist.
• In-house chapel / prayer room
• Sweat lodge

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Important Cultural/Religious Legislation for
American Indians

• The American Indian Religious Freedom Act (1978)
• Resolved certain conflicts between Indian
  religious beliefs and practices and federal laws
  that restricted the exercise of Indian beliefs
  including use of sacred lands and artifacts
• Indian Sacred Sites, 1996, Clinton admin.
  executive order
• Accommodate access to and ceremonial use of
  Indian sacred sites by religious practitioner and
  avoid adversely affecting the physical integrity
  of such sacred sites
• needs only be carried out to the extent
  practical, permitted by law and not clearly
  inconsistent with essential agency function

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Traditional Cultural Advocacy Program (TCAP)

• Established in 1994 under IHS director, Dr.
  Trujillo, affirmed the agencys commitment to
• protect and preserve the inherent right of all
  American Indians and Alaska Natives to believe,
  express, and exercise their traditional
  religions
• IHS staff must inform patients of their right to
  practice native religions and healing practices,
  and when a patient or family member requests the
  services of a TIM, every effort will be made to
  address this request.

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Traditional Cultural Advocacy Committee (TCA) at
PIMC

• In 1989, community members, hospital
  administrators and healthcare providers
  collaborated to form the TCA.
• Membership comprised of American Indian Spiritual
  practitioners, PIMC employees and community
  members. Currently, 15 members attend regularly.
• Reports to the hospitals Medical Executive
  Committee
• Purpose is to proactively recognize opportunities
  for use of American Indian Spiritual Practitioners

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Activities of Traditional Cultural Advocacy
Committee

• Makes Traditional AI /NA cultural spiritual
  ceremony observance available such as Sweat Lodge
  Ceremonies, Traditional prayers and Blessings
• Makes recommendations concerning policies,
  procedures, and standards of practice for AI/NA
  healing methods in the organization
• Participates in the design, implementation and
  evaluation of traditional care and integrated
  services
• Educates staff in areas of Traditional care
• Assists in providing and/or contacting a
  Traditional practitioner to meet spiritual needs
  expressed by the patient

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PIMC Sweat Lodge

• Established late 1990s in response to clients
  identified needs for healing and recovery as
  part of the Behavioral Health program.
• Remains on-site to this day, and continues as an
  integral part of health and spiritual healing
  for many people Native and non-Native

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PIMC Volunteer Chaplains Association

• In 1979, the hospital administration asked an
  American Indian pastor serving in Phoenix to work
  with the Volunteer Director to organize a group
  of local clergy to provide on-site pastoral care
  to patients
• Group became more formalized over the years,
  policies and procedures developed and
  requirements set forth for chaplain volunteers to
  function in hospital setting
• Currently, 9 chaplain volunteers from various
  faith affiliations

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Volunteer Pastoral Care Services

• Visit patients in the inpatient and outpatient
  settings
• Provide religious/spiritual resource materials
• Conduct weekly non denominational service in
  hospital chapel /meditation room
• Provide coverage 24/7 through on call pager to
  address urgent/emergent pastoral care concerns
  (i.e.. End of life-death, fetal demise and crisis
  interventions)
• Coordinate with TCA members when requests involve
  Traditional care

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Staff Chaplain Pastoral Care Services Oncology
Center of Excellence

• In 2001, funding made available to support the
  work of a chaplain to develop a spiritual care
  program through a National Cancer Institute grant
  (NCI 5 UO1 CA 86122-02) to specifically address
  cancer care disparities.
• The PIMC chaplain works in partnership with the
  Southwest American Indian Collaborative Network
  (SAICN), the Volunteer Chaplains Association,
  TCA, and members of the medical centers oncology
  staff to specifically address the spiritual care
  needs of those seeking cancer care

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Dis-ease and Illness

• Can provoke fear and uncertainty
• Can prompt questioning and discovery of deeper
  meanings, values and beliefs
• Seeking care has many challenges
• physically
• financially
• emotionally and spiritually
• Cultural diversity reflects diverse spiritual
  understandings
• Patients and families seek guidance from elders,
  traditional healers, pastors or ministers
• Often seek guidance from more than one group
• Chaplains, Traditional Practitioners, and Elders
• Assist with spiritual interventions- prayers,
  blessings
• Address spiritual questions and concerns

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Individual Spiritual Care Assessments documented
in electronic health record

• Common Interventions

• Common Spiritual Needs

• Grief/loss
• Fear/anxiety
• Powerlessness
• Anger
• End of life concerns

• Presence
• Prayer
• Active listening
• Anxiety reduction
• Coping enhancement
• Verbalizing spiritual/emotional issues
• Spiritual/religious reflection
• Rituals and Ceremonies

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Spiritual Care and Oncology Care

• ...healthcare providers should spend less
  time talking about the intricacies of cancer and
  its treatment and more time looking at, listening
  to, and trying to understand how cancer and its
  treatments affect the everyday lives of the
  people and families we treat.
• (Pelusi and Krebs, 2005)
• So this is how I help people. Even though
  they are at the end of their days, on the verge
  of leaving Mother Earth, there are ways to help
  that individual, and thats my job, my duty.
• Traditional Indian Healer (Carrese Rhodes,
  2000, p.95)

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Next steps for spiritual care provider roles
within IHS and USPHS

• Goal Spiritual care be represented as
  functional/formal component in the provision of
  healthcare at facilities serving AI/AN
• Foster discussion and collaboration across IHS,
  tribes, community agencies and academic
  institutions that are aimed at sustaining a
  presence of spiritual and cultural well being for
  AI/AN patients
• Advocate for professional role in USPHS
  Commissioned Corp that addresses spiritual care
  (chaplain) commensurate with the other uniformed
  services.

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Recommended Reading

• Working with Aboriginal Elders Understanding
  Aboriginal Elders and Healers and the Cultural
  Conflicts involved in their work in Health Care
  Agencies and Institutions, Ellerby, J. (1999),
  Earth Concepts and Biomedical Communications,
  Winnipeg, Canada.
• Sweat Lodges A Medical View, Berger, L., Rounds,
  J., The IHS Primary Care Provider, Clinical
  Support Center, June 1998, Vol. 23, no. 6.
• Where the Lightning Strikes The Lives of
  American Indian Sacred Places, Nabokov, P.
  (2006), Penguin Books.
• Spiritual Care within Oncology Care Development
  of a Spiritual Care Program at an Indian Health
  Service Hospital, Witte, C., Begay, T. Coe, K,
  J of Health Disparities Research and Practice,
  (2011) 4 (3), 54-60.
• Professional Chaplaincy Its Role and Importance
  in Healthcare, A White Paper, eds. VandeCreek,
  L., Burton, L, J of Pastoral Care, Spring 2001,
  Vol. 55, No. 1.
• Understanding Cancer Understanding the Stories
  of Life and Living, Pelusi, J., Krebs, L. (2005),
  J of Cancer Education. 20(1 Suppl)12-16.
• Bridging Cultural Differences in Medical
  Practice The Case of discussing negative
  Information with Navajo Patients, Carrese, J.
  Rhodes, L. (2000), J of General Internal
  Medicine, 15. 92-96.

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Questions?
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Next Webinar SessionTopic Understanding
Contract Health ServicesDate March 20,
2013Time 1000 a.m.-1100 a.m.