SEE THE FULL TEXT OF THIS WEBINAR WITH ADDITIONAL LINKS AND GRAPHICS BELOW…
The Chaplaincy Innovation Lab is joined by a team of chaplains and researchers to discuss practical tips for implementing telechaplaincy, as well as what growing research says about this significant method of spiritual care. A text summary of this webinar, provided by David Lewellen of the National Association of Catholic Chaplains, is available here. Check out also our page on telechaplaincy resources here.
Rachel Payne of Boston University has compiled this topical table of contents to the webinar, which can be browsed to quickly find a given subject, for those who cannot watch the webinar in its entirety.
- Betz et al., “Feasibility and acceptability of a telephone-based chaplaincy intervention to decrease parental spiritual struggle” (2019)
- Chaplaincy Innovation Lab, “Tips on offering telechaplaincy”
- Cobb and Chang, “Spiritual distress is not confined by walls” (2018)
- Exline et al., “The religious and spiritual struggle scale: development and initial validation” (2014)
- King et al., “Determining best methods to screen for religious/spiritual distress” (2017)
- Q&A document
- Sprik, “Example script”
- Sprik, “Telephone script for outpatient setting”
- Sprik and Ingram, “Telehealth and chaplaincy: an approach for chaplains to meet clinical needs during COVID-10” (PowerPoint presentation) (2020)
- Sprik et al, “Using patient-reported religious/spiritual concerns to identify patients who accept chaplain interventions in an outpatient oncology setting” (2018)
FULL TEXT OF THIS WEBINAR –
Wendy Cadge: Good afternoon, good morning. Welcome everyone, depending on where you are and the time zone that you’re in. We’re really pleased to be with you today in this conversation about Telehealth Chaplaincy: An Approach for Chaplains to Meet Clinical Needs During COVID-19. My name is Wendy Cadge. I’m a professor of sociology at Brandeis University outside of Boston, and one of the founders of the Chaplaincy Innovation Lab.
We’re working quickly and doing the best we can through some amazing staff of the lab to respond this week, and to try to be there for you and with you and bring you what you need in this time. We’re really thrilled to have a set of people here to talk with us a bit and we’re going to get to Q&A pretty quickly. All of these folks have done telechaplaincy or have studied telechaplaincy. Let me introduce them and then I’m going to turn the floor to them.
Petra Sprik will begin, she’s a staff chaplain at Levine Cancer Institute at Atrium Health with Deborah Ingram, who is the Chaplain Connect Program Coordinator at Advocate Aurora, they’re going to be talking about two different projects that they did related to tele-chaplaincy.
Daniel Grossoehme who was a pediatric hospital chaplain for 25 years and is now a full-time palliative care researcher will talk about a project that he did about tele-chaplaincy with pediatric patients and their families, and we’re thrilled to have Amy Simpson here who was one of the staff chaplains who did tele-chaplaincy as a part of this project at Cincinnati Children’s Hospital. We’ll hear from Amy. Then Kurt Nelson, who is a chaplain at Bucknell University, will wrap up.
We’re focusing a lot today on health care for all the obvious reasons, but we know that our colleagues in lots of settings who are chaplains are switching to telechaplaincy, and we wanted Kurt to tell us a bit about what’s happening at Bucknell in a way that might be helpful for others of you. Trace Haythorn will lead the conversation.
He’s the Executive Director and CEO of ACPE, the standard for spiritual care, education, and all of the materials that we’re sharing today, as well as the articles we’re discussing are or will be sent to you, either during this webinar, or this afternoon when the video will be available.
Thanks again for being with us. You can type your questions in the question box or in the chat box, and we’ll do the best we can to get to them. A big thanks to all of our panelists for putting this together so quickly. Petra, I’ll hand it to you.
Petra Sprik: Debbie and I will start by presenting a little bit on practical advice that we have accumulated in our own practices. I’ve been doing telechaplaincy for about six years, and Debbie for just over a year herself. We’ll go into some systematic approaches and then just basically how do we do this? Then we’ll turn it over to the other panelists.
Telechaplaincy is a new thing for a lot of people. I just wanted to start off by saying, what is it? Basically, it is communicating by telephone, smartphone applications, live video conferencing, internet interventions, to deliver virtual care, healthcare, in our case, it would be chaplaincy.
This can be done both in real time as we’re doing in this webinar we are chatting, or it can be something that’s done where we record something now, and then it is made available to patients or families later, such as a video, and all of that can count.
“A lot of people when we start talking about this have some fear.”
A lot of people when we start talking about this have some fear. Let us help with that and say this has been happening for a while. We’re joining a practice that has been developed since physicians were making early house calls.
As some of our panelists will tell you, in presenting their own research, we know that telechaplaincy is feasible, and it’s acceptable, with a variety of different patients. Some patients prefer it in person care, and we know that it can help reduce spiritual struggle and it can increase spiritual well-being and there’s certain parts of it like anonymity and being monitored that patients really appreciate.
Why do we use it during COVID-19? One, it’s recommended by public health organizations. As we know, if we’re not going into rooms we can prevent the virus from spreading to patients, family, staff, yourself, which is pretty important. We can also operate within healthcare systems directives, conserve personal protective Equipment that healthcare providers will need during this crisis.
Reduce fear for patients and family, and then we can really expand who we can reach by using these technologies.
At this time, I’ll turn it over to Debbie to talk a little bit on her advice on implementing a system.
Deborah Ingram: Okay, thank you, Petra. As we’re looking at developing a system, we want to encourage you to think systematically and gather a group together to do that. What are the situations you’re going to find yourself in? Think about your current model of care, and is that something that you can carry over into a telechaplaincy environment, or do you need to maybe think about redefining your model of care? What are you going to respond to? Medical codes, spiritual care visits, you do advanced care planning at your site. Really get that defined for yourself.
Also, I would encourage you to think about what is sustainable for you and for your teams. There’s been a lot of conversation recently about our planning through the end of March. But as we’re really following the trajectory of COVID-19, I think we’re becoming aware that this is really going to take us into the summer. What is sustainable for your hospitals, your health care systems and for your teams as well?
Then what is the most ethical way to respond? Do we need to be in the room? Is that the place for us to be? How do we respect the agency of our patients and families as they may be expressing their own concerns about transmission? Then adapting to the restrictions within our healthcare system. Really just encouraging you all to stay up to date on the policies within your own health care system.
Moving on, we want to also be proactive, and do our best to address next steps before they happen. How might we engage chaplains remotely? What if we find that our chaplains are being furloughed? Recently, just this week, we did a technology inventory with our chaplains and identified who has access to laptops, who has the ability on those laptops to access our network from home?
Really thinking strategically about what resources are available to our chaplains today, and how we might be able to use those resources to keep people offering patient care even if we find ourselves working from home.
“Do not expect healthcare systems and telehealth platforms to address chaplaincy as the priority.”
Do not expect healthcare systems and telehealth platforms to address chaplaincy as the priority. This comes from a conversation that Petra and I were having earlier this week. I have been working on some telechaplaincy initiatives for the last year, and six months ago, I was having conversations with groups, and they were really telling me that they had the capacity to get a telechaplaincy program up and running for us.
I went back to those groups last week, and because of COVID-19, they are now really at capacity and can’t help us get our program up and running. We’re having to think creatively about other ways to deliver care to patients via telechaplaincy.
Then using existing systems. What do we have access to? Phones, iPads, in room access. Can we deliver care synchronously, can we deliver care asynchronously? What do you have access to? Even pager technology, I have been investigating within our system, we might think of that as old technology and therefore not viable technology. But I’ve been looking at models that will allow us to cover multiple hospitals with one pager. So, how can we leverage and access what we currently have in place?
I would encourage you to be in communication with the folks in your IT departments, in your communications departments, really engage with your networks within the hospital and see what is, or wherever you’re working and see what is available to you.
I really just touched on that before. Use your professional networks. What are colleagues and other systems doing, as well as how could you know within your own system who might be able to direct you to technologies and platforms that you weren’t previously aware of and that you might be able to use to deliver care over the phone or over video?
Skype and Zoom May not be Considered HIPAA Compliant
Then ask your administration about HIPAA compliance. Skype and Zoom may not be considered HIPAA compliant. I’ve recently learned that different versions of Epic have the ability to offer video chat and video conferencing that would be HIPAA compliant. Again, talk to your in-house folks and see what is available to you from a HIPAA compliance perspective.
Then, just getting back to that question of respecting family and patient agency. Asking ourselves the question, why am I going into the room? Am I going into the room because it’s what’s best for the patient? Or am I going into the room because it’s what I’m used to and feels comfortable for me? Be thoughtful about that question and allow it to guide your steps as you move over. Having said that, I will turn the presentation back over to Petra.
Petra Sprik: Really quickly, we’re going to cover some advice on delivering telechaplaincy, and this comes from three different studies that I did. One, its’ in process, a nationwide study surveying chaplains and what they’re doing to deliver telechaplaincy. Then two studies that we did on the feasibility and acceptability of telechaplaincy at our cancer institute and how patient reported outcomes can be used.
The big piece of advice is almost everybody said in this nationwide study that they were nervous to doing it the first time. When asked what advice they would give, they said, “Just do it.” Go ahead, give it a try. Don’t be afraid of it. The more you do it, the more comfortable you’ll be with it.
Another piece of advice is to check the patient’s chart before you call, if you’re able. You don’t have the context clues that you might have when you enter a room. So, can you look at the patient’s diagnosis, who their emergency contacts are, if there’s any social history? Any of that can help you have a more successful phone conversation or telehealth visit.
“Develop a loose script. We know that chaplaincy is an art and you can’t stick to an exact script.”
Develop a loose script. We know that chaplaincy is an art and you can’t stick to an exact script. But especially in the beginning, having a loose script can help you deliver unified service. We found that to be effective when we were developing our own programs. Some of those scripts will be made available to you. Develop a casual introduction. What we know from one of the studies is that about 25% of people are nervous, or have some form of fear when they are receiving a call from a chaplain.
Introducing yourself from the spiritual care department rather than saying this as a chaplain can be helpful. Or having just a casual conversation as you enter the conversation, saying up front, you don’t have any medical information. All of that can help you have a better interaction.
To ensure that you’re talking to the right person, that it is a good time to talk. We can’t see what people are doing when we call them unless it’s a video conference. Respecting their autonomy, they might be grocery shopping and looking for toilet paper and that’s not the best time to talk to them. Go ahead and ask upfront whether it’s a good time to talk. Just because of HIPAA compliance, make sure you verify that it is the patient.
If you are calling them at home where you might be leaving a voicemail, think through the voicemail before you call, because, for instance that will be in cancer institute, it’s not HIPAA compliant for me to say that I’m calling from the Cancer Institute because that can give away some diagnosis. Come up with that wording beforehand, it can also be intimidating to leave a voicemail the first time. That can help with this process.
Be creative as you deepen the conversation. These are a few things that we have found helpful. Sometimes when chaplains are nervous, that conversation doesn’t go very deep, because they’re trying to get off the phone. Think about talking to your mom or family on the phone, there’s certain things that you can say, to start to deepen that pastoral conversation.
Then have ways of getting off the phone. That’s the opposite of the patients who don’t really talk easily on the phone, and then there’s those that could easily talk for two hours, and we’re trying to reach a lot of patients. Establishing boundaries is something that’s important. Say, I will need to go in five minutes, is there anything else you want to talk about? You can schedule a follow up visit. All of those are good ways to get off the phone. Now we’ll pass it on to the next presenter and take questions later.
Daniel Grossoehme: Hello, everyone, I’m Daniel Grossoehme, currently at Akron Children’s Hospital. Wendy asked if I would talk a little bit about a study that Amy and Judy McBride and I did at Cincinnati Children’s. I was interested in looking at ways to improve parents treatments, or ways to improve parents being able to complete their child’s treatments for cystic fibrosis.
One of things we know is that parents with symptoms of mild and moderate depression, really struggled to get their child’s daily therapies done, and we also knew that one of the things that can exacerbate depressive symptoms is spiritual struggle, negative spiritual coping.
I was wondering that if we had a chaplain who had a fairly structured, semi-structured interview intervention, to deal specifically with spiritual struggle, if that would turn down the volume, so to speak on the depressive symptoms, that would enable them to do a little bit better job adhering to their child’s therapies.
In some sense, because this was a study, the setting’s a little artificial, but we went into the outpatient CF clinic, and screened parents for symptoms of spiritual struggle. If they screened positive, they became eligible to participate in the study.
About three quarters of those who were eligible did agree to participate and enrolled in the study, and they were randomized either to a control condition, in which case, they got a phone call from my research coordinator who talked about the importance of hand washing and other things that were guaranteed not to affect your spiritual struggle. Or you were randomized to a series of three, roughly 30-minute phone calls with one of the two chaplains.
Each of the three phone calls was spaced about two weeks apart. One dealt with spiritual struggles within an individual, the next one spiritual struggles between people, and finally, one’s own spiritual struggles with the divine. Thinking that that would be an increasing depth of conversation. We didn’t think they’d want to perhaps talk about spiritual struggles with the divine right in the first few minutes.
All these were designed to be carried out by a chaplain, and they’re using hospital phone, which help with some of the HIPAA compliance issues, we did not envision them, and I don’t believe either of them actually used their personal cell phones at any time with that.
Generally, it went very well. There was, as to be expected, some missed call appointments. All of these phone calls with the chaplains were scheduled in advance, and it typically took two attempts to actually accomplish one phone call. But it rarely took three or four, only in a few cases.
“… the people who received the intervention, by the time two to three months had passed, their spiritual struggle was lower, their depressive symptoms were lower, they were actually using more positive spiritual coping.”
But let Amy talk about the experience of doing it. I will say in terms of the results, the people who received the intervention, by the time two to three months had passed, their spiritual struggle was lower, their depressive symptoms were lower, they were actually using more positive spiritual coping.
But in the meantime, shortly after they had their third phone call, the level of spiritual struggle actually increased. It looks like by going in and intentionally dealing with someone’s issues, they may temporarily have scored a little worse on the scale, but ultimately ended up scoring much lower and reporting feeling much better about it. Probably, the same thing happens when we come and go in a room, but we hadn’t ever measured that and don’t really have the numbers to back it up. But that’s just something to be cautionary about.
I’ll let Amy pick up here and talk about what it was like to be the chaplain on the phone.
Amy Simpson: Thanks, Daniel. I was excited to try these interventions alongside chaplain Judy McBride. I was also nervous. But let me just start by saying, it works. What I mean is, there were some difficulties and some challenges with it, but I honestly was so surprised at how deep people got on the phone.
It helped, just like Petra was saying to have a script. There were some specific questions we wanted to ask, we could obviously use our own style of conversation to do that. Daniel put together some prompting questions as well.
If there was a well, what do you mean by that? Or just a yes or no, we should try… Obviously, we didn’t have yes or no questions, but when they would just answer briefly, and that was really helpful, too. Because I think it helped me remember that we can go a little bit deeper with the conversation, and it helped them also to understand a little bit more of where we were going.
Judy McBride had an instance where she was talking to a mom while they were at the pool with her kids. There are things, obviously, when you’re calling people on their phone, they’re doing other things. Being open and having a script, what you’re going to say when they answer the phone, and then ask them, is this an okay time to talk?
I think that gives them an option to say no, let’s try something else, or a different time. The non-verbal, not being able to have the verbal cues that you have in conversation can get a little tricky sometimes. You have to be willing to have the silence, because you can see when somebody is thinking, you can watch them before they answer and they’re quiet, you can tell that they’re thinking, they’re going to give you an answer.
“Being willing to have a little bit of that silence.”
You can’t do that on the phone. Being willing to have a little bit of that silence. Then I just was really honest, and would say, “Though I noticed you’re silent, I can’t see you, so, I’m not sure if you want to answer this question. If you don’t, if you’re thinking about it, I want to be mindful of what you’re doing.” I think the more honest we could be over the fact that there are some limitations when you’re talking to somebody on the telephone, it just seemed to go a little bit better, because then they would say, “Yeah, hold on a second, let me think about that.” That helped with the conversation too.
I enjoyed it tremendously, I think it was so successful. I had one dad, who after the third… Because we recorded these, and we told them, we were recording them for research purposes, and after we were done, he said, “Can you please email me those transcripts? Because it was so helpful to be reminded how I could use my spiritual and religious resources to help me during this time.”, I thought, oh, my gosh, yes, of course we will, and that just was so helpful to know that he wanted to look back at those later and have those conversations later.
Since then, this week with the COVID-19, and I was part of a situation where there was a potential exposure, and I watched what happened this last weekend with some staff where they had to be in quarantine for 14 days, some nurses, and all of a sudden it hit me like, oh my gosh, I don’t want to be that person that says, “I might have this, and now I have to go back and tell everybody who I was with, the patients I was with, the staff and to have them be quarantined.”
Importance of Collaboration
I worked closely with the rest of our leadership team, and we came up with a process where this week we went to a telechaplaincy. Now, we were a little bit prepared to do that, and we’re lucky because we have some good resources to be able to do this. But we didn’t right away. Our IT team was amazing in getting us VPN access to those who didn’t have it, getting our workstations up and running.
I’m going to pronounce this wrong, probably, I think it’s Avaya or a Avaya workspace, and that’s how we are calling from our cell phones, and it shows when we’re calling another home phone or a cell phone, it shows that it’s coming from the hospital as opposed to our own personal number and they got us hooked up quickly on that.
That has really helped us, now call in and do our spiritual screenings and our assessments and we have changed our script to include the fact that we’re reaching out to them by phone for the safety of… I’m in a pediatric setting, their child, them and the staff, instead of in-person to decrease the amount of people in the room and the potential exposure, but that we are still available to provide care and wanted to check in on them.
That has been really successful with my colleagues. I want to say one of the things that we have thought about is how can we be creative using this? Especially with staff support with families, we’re calling them, but the staff are really, because we’re down to one person in-house now, and that was difficult for them. As a matter of fact, some of the feedback that we’ve done, it’s been a little bit more difficult for our staff when we’re not just immediately responding to medical teams or traumas, but we’re triaging those.
Created Thank You Video for YouTube
But the families, when we call them, they say, “Oh, thank you. We’re so appreciative you’re doing it this way.” We’re trying to be creative in ways that we can be reaching out to our staff, and we have some younger staff than me, that got on and did YouTube video, just like in five minutes. I obviously am older than them, and I’m not as good at that kind of stuff. But they created a YouTube video, and they send it out to their staff and just said, “Hey, we’re here, we understand you’re going… This is a difficult time. These are some things you can do.”
Then one other thing that’s happening actually later today, is we had a one of our chaplains has a patient who was actually with us 372 days, and it was a cancer patient, and she unfortunately died. The staff really got to know her and her family, and were planning to go for the funeral. Well, they can’t go to the funeral anymore.
What she has done, is she had the staff give her memories, things about the patient, little stories, and she compiled this list and sent it to the family. The family members are going to read those at the funeral. At the same time that the funeral is going on today, the staff chaplain is conducting a time for the staff to come together on Skype, and she’s going to have a little remembrance service.
She’s grabbed our music therapist, who’s going to provide music, she has a candle she’s going to light, and she’s going to read those stories. This family knows that this is happening at the same time the staff feel cared for, and she was just surprised at how many staff want to be a part of this.
I think the more creative we can be, obviously reaching out to our patients and families, but also to our staff in ways that we can provide care, that’s just been some of the things that we’ve done here in Cincinnati. Thank you.
“I’ve been doing telechaplaincy for six days now. I feel like an expert for sure.”
I think it’s me next. Greetings from the world of higher education. I hope everyone’s staying healthy and grounded as possible in this moment in time. Wendy reached out to me two days ago to see if I’d say a little bit about what we’re up to at Bucknell, which feels a little ironic, I’ve been doing telechaplaincy for six days now. I feel like an expert for sure.
I have been resistant my whole career to try to get people connected digitally, really working to get face-to-face meetings, but here we are. I was actually traveling last week with a group of eight students for our immersive interfaith service experience. We were in Baltimore, working on food justice issues, when Bucknell sent the message out, saying that we’re shut down for the rest of the semester, going totally remote, and that life is different.
I think colleges and universities tended to be the early adopters, in many cases on these measures, and I got to see our students process in real time, what they were going through. What it really is, is grief. As we’re working through this moment in time and figuring out what life is going to look like, it looks like grief, and just a little bit of presence with them during that time brought back all of those angry feelings toward administration, all those confused feelings and really brought it back to that sense of grief and ability to process.
RELATED TOPICS: WEBINAR ARCHIVES
I think there’s really good work to be done. We got back and we just tried our best to move everything digitally where we could. I noticed, I think three things in particular. Number one, that a lot of our folks, students, staff, admin faculty are anxious in this moment and really busy. Number two, a lot of our folks are anxious in this moment and really bored, they don’t know what they’re supposed to be doing.
Then number three is that our leadership is getting an incredible amount of abuse via digital means, based on decisions they’re making, and timeframes and things like that. Those all feel like places where we can be present with text messages and phone calls and digital meetups for the folks who are running around trying to figure out what’s going on, and the folks who have no idea what they’re supposed to be doing hour by hour.
Full disclosure, I’m one of those people for sure, and present to the folks who are getting a lot of angry messages from people who are really grieving, but turn toward anger as a pretty natural response. We moved all of our services, all of our text studies online. We’re going to try all of our regular groups as much as possible, via Zoom, Meetup and Facebook Live and those types of things, and we’re really trying to make space with twice a week sessions for members of our community to share the practices that are sustaining them in this moment in time.
Those have just started. I messed up the Facebook feed, but really positive glimmers of hope for those moments. People are showing up, that would be the thing that I would say.
RELATED TOPIC: JOIN OUR PRIVATE FACEBOOK GROUP!
So, try. Zoom is a great program, Facebook has its problems, but folks want to show up, folks want to be together, folks are certainly lonely and disconnected and anxious, some of them running around like crazy, some of them bored, more bored than they have ever been in their life, and some of them taking heaps of abuse in this moment of time. I feel confident across our various types of institutions that we can be meaningfully present in those ways. Thanks.
Trace Haythorn: Thank you, Kurt. That was great. We’ve had several questions, and I’ve tried to group them as we’ve gone along. I’ll do my best to get to as many of them as we can. But let me just start with a quick one. Several people have asked about scripts and PowerPoints. Yes, we will try to make those available with the recording.
Thank you to the panelists for your content that you’ve got there. I know that Amy talked about Avaya as one possibility. If you look in the chat box, or in the question box, you’ll see that we’ve posted the link to that. Thank you to Aaron for finding that for us.
What other platforms are you all using for telechaplaincy? I think that’s specifically to Petra and Deborah.
Petra Sprik: Honestly, I’m working remotely, and we were instructed to dial *67 from our cell phones to make it anonymous and are calling people that way. One of the negatives of that is people tend to distrust anonymous numbers. I will warn you that we’ve had less success with that than when it comes from our hospital line. I did make them from my work phone, prior to that.
Then to just join the voice in continuing to think… That word is not going to come out, not in real time. We are also using various mediums like YouTube, SoundCloud, you’ll have to check with your organizations. I’ve been doing guided meditations, prayers, and that has been a resource that I can offer to people on the phone and that they’ve really been connecting with, pretty frequently. Those are some of the ones we’re using, and I’ll pass it off to Deborah.
Deborah Ingram: Okay, thank you. As I mentioned, we have had to be somewhat creative in this time. We are using an application called PerfectServe, that typically is used for paging on call physicians. But we’ve been working with the PerfectServe team and they are setting up basically a queue for us within PerfectServe, so that multiple chaplains can be present in this queue at the same time.
Then staff either via the PerfectServe application on their desktops, or also an 800 number that we’re going to be providing can reach out and place their requests into the PerfectServe queue, and then it will be assigned to the chaplains within that queue, based on chaplain availability.
It’s not a typical use for that application, but we’ve been able, again, to get creative with what’s available to us right now and use that to provide patient care.
RELATED TOPIC: Effective Zoom Techniques for Chaplains (archives)
Amy Simpson: Trace, can I just jump in here? We have a pastoral care email box that we send emails out of, and we are now creating that as a way that staff can access. Because we’ve suspended all services, worship services and religious services are e at the hospital.
We are opening that up so that staff can be reaching out their prayer request to us that way, as well as families. We’re starting that process soon. Then we’ll have a chaplain each day responding to all of those as well. It can be as easy as setting up a group email for your staff to be able to send stuff in.
Trace Haythorn: That’s great, thank you. Another legal/technical question, one person understood from their administration that CMS has waived some of the HIPAA requirements during the COVID-19, around communications. Any confirmation of that for any of you all?
Jennifer Cobb: This is Jennifer Cobb. I can confirm that the Office of Civil Rights removed that earlier this week. Talk with your local organization, but we’re in preparation to contact patients via FaceTime, Google Duo, Skype, et cetera, and it’s only for this period of national emergency.
Trace Haythorn: Great. Jennifer, I’m glad you’re here, can you say a few more words about what you all have been doing?
RELATED TOPIC: FREE eBOOKS
Jennifer Cobb: Sure. Mostly, one of the things that we’ve… We’ve been involved in telechaplaincy for a very long time, normally making phone calls. However, given the level of staff stress right now, as well as the number of COVID-19 patients who will be in quarantine at home, on top of all of our other patients, we are planning to make phone calls to patients at home as well as contact them by those other means that were previously mentioned.
We’re also anticipating contacting inpatients that way so that we limit the number of chaplains who are going in and out of those kinds of isolation rooms and conserving the PPE for the staff who need it. We’re also exploring ways to help connect patients and their families via FaceTime or these other apps, because as visitors become increasingly restricted, the need for community and connection to family is going to be increasingly important.
Anticipating New Ways to Connect
We’re anticipating finding ways, whether families and patients connect on their own devices, whether we end up providing some devices, but more and more digital connection, both for patients who are admitted, those who are at home, and then mass text messaging for staff. I loved the idea about the guided meditation, Petra and other ways to connect, or ways to push out resources as well.
Trace Haythorn: Thank you, that’s great. The other resource that has been mentioned to us, some of you already have bone marrow transplant units or isolation units, where they figured out a lot of this a long time ago. Both for people who are non-verbal, as well as people who are isolated and can’t connect with other folks. I would encourage people, when they have one of those units within their own institution to take a look at what’s happening there too.
That leads me to another question around working with elders, especially those who may have hearing issues related to telechaplaincy. Can any of you speak to that?
Petra Sprik: That is one of the reasons why I always check the chart before calling, one, to be aware of language issues or things like that and two to be aware if they have hearing issues. Sometimes people can hear on the phone and they’re not sometimes. The phone actually is clear for people with hearing issues, and I’ve heard that again and again, for patients.
Roll with the punches, be aware of it if you can before you call, but sometimes it means talking to a family member. So, checking in the patient chart and seeing if you have that permission to talk to a family member or not, is pretty important in this process.
“It won’t be perfect. Sometimes it’s going to be clunky.”
It won’t be perfect. Sometimes it’s going to be clunky. Hearing issues, speaking issues, asking people to repeat themselves, reminding ourselves that we’re all human in the process, but definitely can present an issue, especially if someone’s deaf, but see who you can communicate through in those cases.
Trace Haythorn: Somebody noted also, somebody with breathing problems who might have difficulty just getting words out within telephony, how hard it is to be able to communicate in that way.
Petra Sprik: Sometimes I’ve said, “It sounds like you’re out of breath. Can I call you back at a later time? Or is there a better time to talk?” Or just getting it done five minutes at a time and following up five minutes every day.
Trace Haythorn: That’s great. Thank you. Daniel, somebody asked specifically what the screening tool is that you all use in your research?
Daniel Grossoehme: Sorry, took a minute to figure out how to unmute myself. We used the Brief RCOPE by Ken Pargament, and specifically pulled out the seven negative religious spiritual coping items and screened that. I believe the options are like, I have never used this coping style, I’ve used it occasionally, I use it a lot, I use it most of the time.
Any response other than I don’t use it was considered a positive screen, at least enough to warrant a phone call to check out.
Trace Haythorn: Nice, thank you.
Daniel Grossoehme: Let me leap back in. This study is now two/three years old. If I were to do it today, I would use the spiritual struggle scale that was put out by Julie Exline, and colleagues from Case Western University, and I think the date on that is 2018 or 2017. Either of those scales are good, but if I did it today, I’d use Julie Exline.
Trace Haythorn: If you are looking at the questions, circling back to the earlier question about HIPAA constraints, there is a link now, Edward Bernstein has put into the question box, that is the HHS announcement. You can see the actual document related to that. Thank you for that, Edward. It takes a village. It feels like we’ve got all hands on deck right now. Even in this webinar, we really appreciate the help.
Let me toss out another question that is interesting, because it was asked in two different directions. One person asked if it was ethical to not go into a room, when doctors and nurses and therapists are. Another person asked if it was ethical to go into a room, when all the procedures were saying we shouldn’t and that we were increasing the virus vector. What do you have to say, panel?
Petra Sprik: I think one of the things regarding ethics is we have to think of the motivation behind it, of, are you going into the room out of your own, I need to get in there and I need to create a change. Is the clinical team telling you something? If a patient’s dying, that’s one thing. If a patient just might be a little down one day, that’s another? Considering those circumstances.
I think part is why do you have to be in person? Each room has a telephone. In the case of a dying patient, of course, that’s not going to work. In case of a patient who’s sitting there, unable to talk on the phone, why not give that a try first, maybe use it as a screening method?
I haven’t thought of all the ethics of this, but, people are unnerved, and yes, we are essential to the work but we’re essential in certain cases. So, how can you screen for those cases might be a good ethical question to ask, just before knocking and entering. I think rounding the unethical.
Trace Haythorn: That’s helpful.
Amy Simpson: I think it’s really hard because it’s been difficult for us, because there is such a benefit in being in person. Our team has met every morning for an hour long Skype call to go over these changes. I’ll be honest, we have struggled. I think it’s one of those where we are not trying to say that it matters to have a chaplain there in person, that’s not it.
We’re in a situation that is new, and sometimes the best care that we can give is by not being there in person. I, again, go back to that I don’t want there to have to be 14. 20 nurses or medical team member nurses or doctors that have to go in quarantine because I needed to be there in person.
It is tough, and it’s not… I keep reminding our team and myself, this isn’t permanent, this is for now. Not that telechaplaincy, we can’t use it all the time, I think this is excellent, it’s given us an opportunity to try something that we might not have tried, or one of us would have tried. I just think it’s for a brief time.
Trace Haythorn: Yeah, it’s certainly a time of great experimentation. Let me go to Kurt, specifically, somebody asked if you could talk about those twice weekly check ins, what’s the format for those?
Kurt Nelson: We’ve asked members of our community just to share for five minutes about we’re calling it sustaining practices for perilous times. I just introduce them, they talk for five minutes about practice that’s meaningful to them. We open it up for five minutes of questions and let folks go on their way. You can see them on Facebook, I promise, next time, Tuesdays and Thursdays at 3:00, if you want to join us, you’re welcome to Rooke Chapel at Bucknell University.
It was our Zen advisor who shared the first one, and he just gave a really lovely five minute take on breath meditation and told people to be gentle with themselves. On Tuesday, we’ll hear from our Muslim chaplain, and I imagine he’s going to talk to us about prayer practice.
Trace Haythorn: That’s great. Thank you. Take a look in the question box, and you’ll see some resources from some other folks too, the folks at the Brigham and Women’s Hospital developing a spiritual care Instagram account for staff. Then there’s also a series of questions about doing telechaplaincy with other constituencies. I talked about elders.
There’s a question about working in behavioral health, there’s another about working with people who have limited English or non-native speakers, or maybe don’t even have English. How does it work in those contexts? Can you all speak to other of those?
Petra Sprik: From serving chaplains across the US, there’s various ways that people have mentioned. Some healthcare systems, for example, a Spanish speaking patient have an interpreter that you can have as a third line, coming in. That could be an option for that. I would talk to your interpreter department. If that doesn’t work, and email is permitted, or you get an agreement from the patient in person, that email, you can use translators that way as well, or various people have.
Behavioral health, different organizations have different practices, and my guess is it looks different with COVID-19. Again, and again, I heard from behavioral health practitioners that patients actually wanted it for a lot of behavioral health patients gave them a sense of peace, because they didn’t have to, for example, with schizophrenic patients, wonder if…
They didn’t wonder as much if the voices they were hearing when the person was on the phone were real, and they could engage in a different way. I heard that from several chaplains.
But I would, in that case, if that’s your environment, be talking to other practitioners, be talking to the psychologists on your team, be asking whether that’s appropriate. It will vary. I think just remembering we’re not alone, especially in COVID-19. I think various practitioners will talk across and say, “Yeah, I would recommend this or I wouldn’t recommend that.” Functioning as part of that team.
Trace Haythorn: A question too… A couple of different versions of this question about, particularly when a patient dies from complications related to COVID-19, the family often is not allowed to be present at that point. They may not have been present for several days, has anyone developed any kind of process for grieving and know that… Lt me caveat this by saying we’re working on a webinar specifically about this.
Be curious to hear if you’ve got any seeds that will help us as we develop this out, but any experience with this at this point? Crickets. May it not be your experience.
I can imagine that the kinds of things that we often use in those moments become then the surrogate for the person when you can’t be with the body. Pictures, photo albums, video, whatever, you might have, the chance to do, at least some initial processing. It’s also tied to a question about how then do you connect with community clergy or refer to community clergy, and what role can they play when there’s such stringent limitations on visitation?
RELATED TOPIC: SIGN UP FOR OUR NEWSLETTER SO YOU KNOW WHEN THE NEXT WEBINAR IS!
Deborah Ingram: I will say, from our perspective, we have developed relationships with our community clergy, and we are in regular communication with them, and really encouraging them to do some of the same things that we’ve been talking about today.
I think Petra mentioned a few minutes ago, everyone has a phone in their room. If they’re not able to come and visit those members in person, to be contacting them in their rooms over the phone, and supporting the families in ways that are appropriate as well, given our restrictions around social distancing.
Trace Haythorn: Thank you. Anybody else want to add to that?
Amy Simpson: Ours is pretty similar, in just helping them figure out creative ways to connect with the patients and with the families.
Trace Haythorn: The other interesting question is, how to use some of these technologies, or now that visitors have been so limited, particularly with COVID-19 patients, how do you make connections from home or from outside of that space? Not just between the chaplain and offering spiritual care but helping facilitate the family and loved ones interactions?
Jennifer Cobb: This is Jennifer. I mentioned that a bit earlier, and one of the things that we’re finding to be incredibly helpful is helping the patient FaceTime with their family, or contact their family by phone, whatever their normal… Most people FaceTime in some way, shape, or form or use some similar kind of app. Whatever that is that they can use their own device to be in conversation is very helpful. I think most of our facilities do offer free Wi-Fi.
So, how can we help them leverage that for connection and continue to help them keep their community around them, virtually, if not in person?
RELATED TOPIC: GRIEF: THE NEW NORMAL
Trace Haythorn: Somebody raised a good point of, as the numbers increase, where family members will wait, that most ICU waiting rooms have limited capacity, and are the institutions thinking about triage and family members, so that they have a place where they can be?
Amy Simpson: That’s what our Cincinnati children’s, they’re doing. Social work is we are very lucky to have many social workers and they are really helping us out with that. They continue to have to change where the families can gather, but are being creative.
Ours has a two-person visitation lists now. In special circumstances like end of life, how we can continue to maintain two persons, but potentially rotate those out, and it continues to change every day, our guidelines change all the time of what we can do and what we can’t do.
Amy Simpson: Our social workers have been really helpful with our families and with us as well, in helping us work through that.
Trace Haythorn: That’s great, thank you. We are just about at the end of our time. I feel like we could continue this conversation through most of the night and try to figure things out together. Know that the lab will be working on developing some things, and I’ll let Michael close this out in just a second. But just to say thank you to Petra and Deborah, to Daniel and Amy, to Kurt and Jennifer.
Thank you for taking the time out to give some thought to this, and to offer to our colleagues. Thank you for those of you who asked questions and made comments. We will try to gather all this stuff together and I’ll let Michael share the details of how that’s going to happen.
Michael: All right, Trace, let me just turn on the webcam here, so I’m not a disembodied voice. All right. Thank you all for being here today, and to all of our panelists, this is just so timely and helpful, and I really appreciate the great balance that you struck between the theory underlying all of this.
But just the practical elements of how do we do this right now? Because these are not things that people need to know how to do a month from now or a year from now. It’s like they’re going to get off the webinar and go do it right now. So thank you very much.
Everyone who is on this, we will send this out very, very soon. We have to do a little bit of minimal processing on it, and then we will upload it, it’ll be on the Chaplaincy Innovation Lab website. Everybody who registered will get an email that has a link to that recording, and then we will also include all of the handouts that are listed in the controls over there, all of the materials that were mentioned here, the slideshow will be there, the sample scripts, all of that will be included in that message. You’ll have it handy for you.
If you thought this was useful, please do pass it along. Let everyone know that it’s still available. It’ll be on the website indefinitely. We want this to be a resource for everyone, as long as possible. Thank you all for being here. I should ask the panelists; do you have anything else that you’d like to add before we close out?
Well, we will be back together next Tuesday, March 24th at noon, for another one of our town halls. We did one this past Tuesday. It’s just an open space for chaplains to come and talk about what they’re experiencing, what they need to exchange advice.
We’re going to have Donna Mote, who is a disaster chaplain and also the chaplain at Hartsfield Jackson International Airport, which means that she has a lot more free time these days. Eric Skidmore, and Peter Gudaitis, disaster chaplains as well.
RELATED: DONNA MOTE WEBINAR
Some people that have some frontline experience in not necessarily medical crises, but certainly had to deal with moments of extreme needs. Please do join us. The registration link is on our website, and we hope to see you next week.
Thank you all for joining us. Have a great afternoon.
NEXT WEBINAR: CLICK HERE TO SEE THE SCHEDULE