Spiritual Care Verbatim - Weebly



Patient initials: DChaplain: Jessie BazanRace and Ethnicity: WhiteLanguage(s): EnglishReligion/Denomination/Spirituality: CatholicGender: M___ F_X__ Age:_middle-aged__Disability: UnsureMarital status/sexual orientation: UnsureSocioeconomic (employment): UnsureMedical Issues: UnsureDate of visit: 7/16Unit: AMHULength of visit: 10 minutesVerbatim #: 3Note: The spiritual care encounter must have occurred within two weeks of this clinical presentation. You may focus your verbatim on an encounter with another staff person(s).I. KNOWN FACTS: Summarize facts you had about the person (age, gender, diagnosis, faith tradition, etc.) before the visit.Heading into the visit, I had no information about the pt, not even a name. All I knew was the room number. PLAN FOR THE VISIT:Describe your reasons for the visit. Include a summary of previous visits, if any; your intention for this visit; particularly the spiritual issues you anticipate in this visit.Spiritual Care received a call at the front desk that the pt in the AMHU NA17, bed 2 would like communion this afternoon. The message got relayed to me, so I went down right away. My intention for the visit was to bring the pt communion. I was also open to talking more with the pt if she was interested in further spiritual care. When I met the pt, I immediately recognized her from group last week. During that group session, D struck me as having more self-control and focus than the other pts. OBSERVATIONS:Write your impressions and observations as you entered the room (aura, pictures, flowers, mood, etc.). Describe the patient, others, and the physical arrangements in the room - where and how the patient and others were located in the room, etc. I walked into the AMHU and asked the nurse at the desk about the pt. I could see room 17 from the desk. The door was open and no pts were in the room. The nurse said, “It must be Deb who wants communion. I think she’s in the cafeteria. She’s the one with longer, dark hair.” I walked into the cafeteria to find Deb sitting at the table, working on a crossword puzzle. There was one other man in the room, but otherwise it was pretty quiet and bright with natural light. THE VERBATIM VISIT:In the table that follows, put each exchange of dialogue on a separate line noting the speaker with initials and numbering the exchanges. In the External Dialogue column give a verbatim (word for word) account of what was said including a word for word account of all prayers, rituals, and blessings. Indicate incidents such as pauses, interruptions, etc. Nonverbal communication should also be noted in parenthesis. In the Internal Dialogue column indicate associated thoughts, feelings, and intuitions. There is no need for analysis or interpretations here; save these for the Analysis section (V). SAMPLEInitials#External DialogueInternal DialogueJA1Mr. J. I’m Jim Allen, a chaplain intern.FJ2Hello, I’m F.J., who did you say you were? There is a slight pause here as the nurse enters to take Mr. J’s vital signs (pulse, temperature, etc.)JA3I’m Jim Allen…VERBATIMInitials#External DialogueInternal DialogueJB1Hi, I’m from Spiritual Care. We just got a call that the pt in room 17 wants to receive communion, but I didn’t get a name. MP2Oh, hmm … that must be D. I think she’s in the cafeteria.JB3Ok, thanks.JB4Hi … are you D?I recognize this woman from group last week. She’s still here?D5Yes.JB6Hi D, I’m Jessie from Spiritual Care. We got a call that you wanted to receive communion. Is now a good time?D7Yes, now works. Thanks for coming. I’d like to receive every day. I haven’t received communion since Tuesday.JB8I’m sorry about that. Hmm, I wonder how you got missed. I’ll be sure to check in upstairs to make sure you get a visit tomorrow. Would you like to stay in here or go to your room? (I started to pull out a chair for me to sit.)D9Well, uhm … if it’s okay, let’s stay here. JB10Perfect. (I sit down.) So how’ve you been feeling today? D11Well … (D’s eyes well up), not very good. This morning was okay, but it’s been a hard afternoon. I’m feeling very anxious about my court date on Monday. Tears – I should ask what’s going on here, like we do in CPE.Sam suffers from anxiety.JB12Oh no, I’m sorry you’re feeling anxious, D. Would you like to tell me more about what’s going on? I’d love to listen to her if she wants to share with me. Sam is on my mind now, but most of my focus is on D. D13No … talking about it just makes it worse. We had a family meeting yesterday and talking about it just made me more anxious.It seems she has a lot bottled up inside. She teared up at me even asking how her day was going. Should I push her and ask more questions? No, I want to respect that she doesn’t want to talk today … but I’ll plan to bring her communion the next few days. Maybe she’ll want to talk more this weekend. JB14That’s totally fine. (pause, I take a deep breath, smile at D and begin the communion rite) Peace to you, D, and peace to this house and all who live in it.D mirrored me and took a deep breath, too. She seemed to relax a little and returned the smile. The message of “peace” seems to be comforting for her to hear. I want to take this ritual slow. JB15(I put my palms up on the table in prayer) Brothers and sisters, let us acknowledge our sins, and so prepare ourselves for this sacred celebration. Damnit, I did the “brothers and sisters” thing last time! There aren’t any brothers here! I want this to be personal for D, not like I’m just reading words off a piece of paper. JB16You brought us to salvation by your paschal mystery: Lord, have mercy.D17Lord, have mercy.JB18You renew us by the wonders of your passion: Christ, have mercy.D19Christ, have mercy.JB20You give us your body to make us one with your Easter sacrifice: Lord, have mercy.Oh shoot, someone just came and turned on Judge Judy in this small room. It’s really loud.D21Lord, have mercy. JB22May almighty God have mercy on us, forgive us our sins, and bring us to everlasting life. Amen.JB23Let’s pray with a reading from the Gospel of John. “Jesus says: “I am the way and the truth and the life. No one comes to the Father except through me.”Quick scan – is there a reading about peace? (I wish I had paused longer to find a reading that might speak to Deb’s anxiety.)D24(Looking perturbed) Excuse me, excuse me, would you mind turning the TV off while we’re doing this? It’ll be like five minutes.Hey, I visited that guy yesterday!Patient 25Oh, yeah, sure, sorry. (leaves room)JB26“Jesus says: “I am the way and the truth and the life. No one comes to the Father except through me.” (pause)JB & D27And now let us pray with confidence the prayer Christ taught us … (Deb and I pray together) Our Father who art in heaven, hallowed be thy name. Thy kingdom come, thy will be done, on earth as it is in heaven. Give us this day our daily bread, and forgive us our trespasses, as we forgive those who trespass against us, and lead us not into temptation, but deliver us from evil, Amen. JB28(I open the pix) Behold the Lamb of God, behold him who takes away the sins of the world. Blessed are those called to the supper of the Lamb.D is gazing intently at the host. This is a beautiful moment. Let me soak in these words. Here’s Jesus, bringing her … us … comfort. D29Lord, I am not worthy that you should enter under my roof, but only say the word and my soul shall be healed. JB30The Body of Christ, Deb. Ah – her name’s D, right?! Quick scan of medical bracelet didn’t help. I’m pretty sure it’s D. Why do I have such a hard time with names?31(silence)God, please be with D. Please bring her peace. Whatever she’s praying for now, I pray for that, too. Thank you for this time together. … let me give her a little more time. No need to rush. Her eyes are closed and she looks to be in prayer. Let’s just sit in the silence for a bit.JB32O God, who have willed that we be partakers in the one Bread and the one Chalice, grant us, we pray, so to live that, made one in Christ, we may joyfully bear fruit for the salvation of the world. Through Christ our Lord.Whoops, forgot the “Let us pray” part to start.D33Amen. Thanks!Oh, there’s still a closing blessing … ah well. JB34You’re most welcome! I’m glad we could celebrate together. That’s such a pretty necklace you have there. What’s the medallion of? D35Oh thanks! This one is of Mary. She appeared to St. Catherine … I think it was St. Catherine of Sienna once. And my daughter got me this crucifix from (I don’t remember name of European city.)Maybe she’d like to pray the rosary? I could bring her one tomorrow?JB36How nice. Those might be good to clutch when feeling anxious. Well, D, I’m actually working this weekend so I’ll be sure to come with communion the next few days.Her eyes lit up. She seems comfortable with my presence. I’m glad. D37Oh, that would be great! Thank you.JB38Great, well then I’ll see you tomorrow. Bye, D.D39Bye. (D grabs her crossword book and begins again.)(For additional rows of dialogue, go to the bottom line of the table, right column and hit Tab. To remove lines select the lines you’d like to remove, go to Table/Delete/Rows.) V. ANALYSISReview and evaluate this visit as you experienced it. Refer to the verbatim dialogue to reference, note, or explore your analysis of the verbatim. The PersonHow did the person(s) relate to you personally, emotionally, mentally? (e.g. was this person open, guarded, friendly, anxious, fearful, resigned, calm, sad, accepting, etc.?). What were the verbal and non-verbal cues? What were your interpretations of how s/he was encountering you? The pt communicated openness and friendliness to me. She had a very gentle, almost motherly presence. (I later learned she is a mom herself.) She talked softly, but confidently, and was able to ask for the care she wanted. Her eyes communicated a gratitude that I had brought communion to her. It seems to be an important part of her spirituality. What do you know of the person’s family life, relationship with friends? What is this person’s cultural/faith history? How is this person/family/significant other(s) responding to the illness, crisis, treatment, etc.? What dynamics and/or issues were present with others in the room? How were they interaction with each other?I didn’t recall too much of what D shared in group last week, except that she mentioned taking her children to RCIA classes. So, I knew D was a mother … and I believe she mentioned a husband, too, but I’m not entirely sure. One daughter had been by to visit, D mentioned. D also said there was a “family meeting” about her health. This leads me to assume that her family is at least somewhat engaged in her care plan, although I am not sure to what extent. Ethical ConsiderationsBased upon information that you possess from rounds, conversations with staff and the patient, do you see any potential ethical issues arising out of this hospital stay for him/her? (e.g. Does the patient have enough information to make an informed choice regarding treatment? Assuming that the patient is competent to do so, has s/he been fully appraised of No CPR orders? DNR/DNI orders? Is s/he treated as an individual?I do not see any potential ethical issues. What are the ethical implications for the system(s) involved?Again, I am not aware of any ethical implications. The ChaplainHow did you relate to this person personally, emotionally, mentally? Identify issues, feelings, thoughts, questions, judgments, and intuitions that were stirred in you. Identify and discuss your role in this situation. I noticed myself feeling very comfortable around this pt. I took this request for communion immediately after an insightful IS conversation. The IS left me feeling significantly more relaxed than I had earlier in the day. Maybe I was also ready to take a short break from reflecting on my own life! However, most of IS was spent talking about my brother, so he was still on my mind as I went to this visit in mental health. I particularly thought of him when D mentioned her own anxiety. Perhaps this fostered my desire to connect more with D. After the visit, I was curious about the circumstances that brought her into the AMHU. Obviously something serious must have happened if she’s been here for at least one week and has a court date next Monday. But I kept thinking about how “put together” she appeared on the outside. D reminded me of lots of moms I met in elementary and high school. I also became curious about length stay for pts in the AMHU in general. How is length of stay determined? A pt I visited earlier was in the hospital because she had tried to die by suicide … and was discharged after two days. D has been in at least one week. Recall what was going on inside of you throughout the visit. Did your mood change? If so, why? How did you think/feel about yourself (professionally and personally) during the visit; about the person(s) to whom you were talking; about the staff? How did our internal dialogue/lens, intuition influence your spiritual care? I responded so quickly to the request for communion that I didn’t have much time to start thinking or wondering about the visit until I got there. This was probably helpful, as I felt freer to respond to the pt and situation in front of me. Sometimes if I get a lot of information about the pt from their chart ahead of time, I’ll start planning my visit. What prayer might work for this pt? What sorts of stories might he/she tell me? It’s good to be prepared to an extent, but my best visits come when I don’t think through everything ahead of time and instead allow myself to be present to what the pt is sharing at that moment. Interpersonal DynamicsCharacterize the manner in which you and the other(s) related. What facilitated or hindered communication? Point to a significant moment(s), missed opportunities, turning points. What inspires you about this visit? I wonder if the setting was one of the reasons D didn’t want to talk during this visit. We were in the dining room of the AMHU. There was quite a bit of commotion, especially when another pt turned on the TV. I noticed D became distracted when this happened. Maybe she also didn’t feel comfortable expressing her emotions in a public place. At group last week, she spoke in a calm, matter-of-fact way. I wonder how the conversation would have been different had we been alone in her room.I was inspired by the look on D’s face as I said, “Behold the Lamb of God. Behold him who takes away the sins of the world. Happy are we who are called to the supper of the lamb.” It was almost as if she had a twinkle in her eye as she looked at the body of Christ. I felt something move in my gut at that moment. Upon reflection, what would you like to have done differently? I may have asked one more time at the end of the visit if D wanted to talk about anything that’s going on. Her teary response earlier indicated some pretty strong feelings. I also would have taken a minute or two to look over the Gospel reading options for distributing communion. I ended up reading the first reading I saw, but I wonder if there was a reading that spoke more to D’s anxiety. (When I followed up the next few days, I brought different Gospel passages that focused on peace.)If there was there anything pertinent from a family systems perspective regarding this visit please describe it. Nothing to note.Theological/Spiritual ThemesIdentify and discuss theological/spiritual themes and issues for this person, family, significant other(s), and for you. Describe the sacred/holy moments. Refer to the sacred writings, symbols, doctrine, myths, pieces of religious history, and/or images that relate to this encounter. Make an assessment identifying the major spiritual need(s) and/or gifts. Outwardly, I observed D asking for daily communion and wearing a necklace with a cross and Mary medallion. Her Catholic faith is important to her. Inwardly, D expressed just a little of the anxieties clouding her these days. When I got back to the office, I searched for Scripture passages that might bring some peace and comfort to D. The passage that stood out is from Matthew 11:28-30, which says, “Come to me, all you who are weary and burdened, and I will give you rest. Take my yoke upon you and learn from me, for I am gentle and humble in heart, and you will find rest for your souls. For my yoke is easy and my burden is light.”What/where are the most fruitful opportunities for building on gifts; for becoming more aware of spiritual growth/formation for the person/family/significant other(s)? For you?Some spiritual growth for me could come in learning more about the ritual of bringing communion to the sick. Particularly, I’ve wondered which parts of the rite are “necessary.” I usually through the entire card, which takes about five minutes. If I’m in a situation where the pt needs to get to another appointment, which parts can I leave out while still providing a reverent, meaningful service? Also, I’m curious if any Gospel reading can be used. There are five or so options listed on the ritual prayer card, but I wanted to pick a reading more personalized to D’s situation. What were the explicit and implicit beliefs, meanings or understandings expressed? See above in answer 1.Artistic ExpressionYou are invited to creatively express what you experienced in the spiritual care situation. Feel free to draw a picture(s), write a poem, play/compose music, to artistically express your feelings, thoughts, and institutions. The mystery of faithIt wasn’t supposed to be like this.Daddies aren’t supposed to bury daughters,especially daughters who weren’t sick.She wasn’t even sick —?and now …?and now …?It wasn’t supposed to be like this.?And what about the other?What is she still doing here?She was supposed to go home in a box.Heart stopped, kidneys failed, chalked up as dead.And now …and now …It wasn’t supposed to be like this.?But it happened.One died, the other lived.It’s terribly unfair,terribly gut-wrenching, and terribly true.?I hear you.And I want to help. ?I want you to take this, all of you.Take the supposed to’s, the why me’s,take the missed birthdays and stolen kisses,and give them to me.?The raw ache of your grief is tugging on my heart,for my body, my tear-stained cheeks,my very flesh, was given up for you.Pour out your heart, like I poured out my blood,for the I’m sorry’s, I love you’s,thank you’s and goodbyes,that never got said?Howl and rage, weep and wail.Do this in memory of your precious angelswho were supposed to make it and didn’t.For this is the mystery of faith.Chart NoteWrite verbatim the note you charted in the patient’s medical record. If you did not chart a note in the patient’s medical record, describe in this section the information you believe you would include in the chart. I did not chart this visit because I did not have the pt’s MRN. I also figured that normal communion visits are not charted, so I didn’t think it was necessary to char this one. Learning ProcessWhy did you write up this particular visit? Where/how do you want to focus the discussion? What do you want to learn from this encounter? Does it relate to your goals? If so, how? What is your future plan for involvement with this patient/family, significant other(s)? Earlier in the week, Julie mentioned being interested in learning about the ritual of Catholic communion. I thought sharing this visit would offer a set time to discuss the ritual. I also had quite a bit of internal dialogue going on in my head, so there was more to discuss. This visit related to my goal of taking visits in the AMHU. ................
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