Background:
During the summer of 2019, I attended a 6-week training conference in Southern California aimed at educating graduate students in healthcare disciplines the importance of spiritual care. My perspective was exceedingly grown. Over the course of those 6 weeks, I learned just how much a person’s response to injury, motivation to continue with rehabilitation, and overall health is tied with their spiritual beliefs (or lack thereof). This appreciation grew substantially as I began to take care of patients during my clinical rotations. Physical Therapists have a unique opportunity to establish strong relationships with their patients due to the significant amount of time spent working together to achieve the patient’s goals. During this time of collaborative work for the patient’s betterment, it is our responsibility to coordinate the patient’s care with attention to the patient as a whole person.
I knew this was going to be the topic of my capstone after one afternoon in clinic. I was briefed by a nurse that this patient was very anxious, uncomfortable, and unwilling to work with any of the medical personnel. Upon the subjective examination, I asked this patient about the presence (or lack thereof) of a faith or belief system. This patient began to cry and informed me of a death in the immediate family that occurred the night before, and how hard that has been to reconcile that event with their belief system. Following that conversation, I noticed the patient’s heart rate and blood pressure decrease along with her discomfort, and the rest of the evaluation went much more smoothly.
After this patient interaction, I thought to myself, “people need to know about this.” My capstone project has been a labor of love for people and my desire for patients to know that whole person care is important. Specifically, that while they may have an ache, pain, or dysfunction in a body region (biological), the human person is a complex interplay of parts impacting each other. Caring for a person’s biological needs and their spiritual needs can have significantly positive impacts on the well-being of a whole person.
Statement of Need:
What sparked this interest in me and kept the flame burning was the desire expressed to me for this care by patients’ themselves. I can’t count the number of times a patient has said to me following a spiritual screening, “No doctor has every asked me those questions before” or “I wish my other doctors would ask me those questions.”
I think a lot of us (including myself) are unaware of how many people are struggling in a world of isolation, condemnation, and loneliness. This has certainly been amplified during the past 2-years of the COVID-19 pandemic. One patient told me at the end of the plan of care, “you’re the only person I’m able to talk to about these things.”
It is very possible to be physically cared for without feeling cared for; I think there is more of a need than we realize for this facet of care.
Purpose:
There’s been an excellent trend in Physical Therapy practice over the last decade with more emphasis on the whole person. The consideration of how a person’s emotional, mental, and social health impacts their physical health is important for all health care providers to keep in mind. These factors (such as anxiety, depression, etc) are a part of regular subjective screenings and are deemed “yellow flags.”
The primary purpose for my capstone is to advocate for “spiritual health” to be added to that list of independent variables – for Physical Therapists to include a “spiritual health” screening as part of their yellow flag screening during patient subjective examinations. By doing this, I think we will have a better awareness of the patient’s well-being and we will be practicing within the available evidence which supports the positive impacts on the patient’s overall health from spiritual assessment and care.
Presentation Assessment:
Throughout the formulation process of this presentation, I received feedback from my advisor committee on how to communicate this information most effectively to my audience. With the help of my committee, I designed this slideshow to present information about my topic in a way that acknowledges and addresses common counterarguments to why this form of care should not be implemented into practice. By doing this, I can succinctly present information in a way that doesn’t drag on and take up a long duration of time – losing the attention of my audience.
Additionally, I employed strategies to keep my audience engaged by not including excessive amounts of information on slides and by introducing myself at the beginning of the presentation to make it more personal.
Products:
For Physical Therapists, I created a VoiceThread presentation where I explain what spiritual care is, how to implement it, and why to implement it. Throughout the presentation, I analyze what current literature has to say about the impact of spirituality and spiritual assessment on patient health.
https://unc.voicethread.com/share/19855732/
For Physical Therapists and patients, I developed a feasible, efficient spiritual care questionnaire that the patient can fill out at any point of the evaluation. This would serve as a substitute and/or complement to verbal spiritual care assessment to any Physical Therapist who deems it helpful.
Evaluation Component:
Throughout the project, I utilized the expertise and suggestions from my committee, working with them to come up with products that are objective, purposeful, and useful to Physical Therapists.
For the purposes of feedback on my presentation and product, I created this feedback form for viewers to fill out after viewing my presentation/products.
Self-Assessment:
Throughout the formation of this presentation, I received feedback from committee members and others who were concerned with spiritual care in relation to the scope of physical therapy practice. Additionally, concerns were voiced to me regarding the objectivity and nature of this project – whether it was to be informative/educational, or persuasive. My goals for this project were to be educational and persuasive, using objective data provided by research to persuade my audience into adopting this form of screening to their own evaluation “routine.” The bottom line, I want to share what I’ve found to be true about the spiritual needs and care of our patients as supported by the evidence and my own experiences.
This project taught me how to search for and analyze objective data in an effort to test my hypotheses and determine if there is support of this practice strategy. I also learned about effective strategies for presenting information to an audience on a topic that many deem controversial. The skills I learned throughout the creation of these products will help me navigate future situations that may be tense or uncomfortable, as well as developing my presentation/leadership skills for future endeavors.
Acknowledgements:
To my primary advisor, Michael McMorris: Thank you for shepherding my vision and helping to turn it into a reality. Your honest feedback and desire to tell me what I need to hear, not necessarily what I want to hear is one of the main reasons this project exists.
To Bob Mason, the director of the Whole Person Care Preceptorship: Thank you for shining light and for igniting this passion within me.
To Daniel Alford: Thank you for allowing me to practice incorporating this form of care into my own clinical routines and for fostering an environment of mutual growth and respect throughout this process.
5 Responses to “Integrated Spiritual Care and Assessment into Physical Therapy Practice”
hruss4
Hi Matt,
I remember speaking with you about your capstone a couple of times during the semester. It’s funny cause I definitely asked myself and maybe you as well, some of the counter arguments you poised during this presentation. The strengths of your presentation was taking potentially a controversial topic and making it objective while also acknowledging the counter arguments to it’s implementation. You did a great job considering the counter points physical therapist would consider when deciding if they wanted to add this to their examination process. The main thing I was concerned about when we talked about your presentation earlier in the year was if the information was going to be unbiased. I appreciate how you made it very clear that the particular religious identity of the patient did not matter. Although, I do wonder how a referrals for non Christian patients would work. In hospitals chaplains are the main referral source and I know they are non-sectarian, but they do have a historical ties with Christianity. I wonder how these referrals would be interpreted by patients who do not identify as Christian. In addition I have always felt that the Chapel’s located inside hospitals were primarily geared toward Christian believers, not all religious beliefs. So I wonder if there would need to be a revamp of hospital spiritual care in order for this subjective evaluation to reach all people. Regardless, I think you made a great argument for why religious screening should be included in a Physical Therapy examination. Like other things that we have learned in school, in order for this to have widespread application the physical therapist would need to believe in its value. You presented some compelling research that demonstrated the positive physiological impact of faith questioning. My favorite thing you mentioned in your presentation was how asking these questions can increase the connection with our patients. I whole heartedly agree with you, patients want to be seen. And if being seen helps them get back to their goals, then that is something to consider in practice. Thanks for great thought provoking capstone. Super solid!
admutch
Matt-
After discussing the Capstone Project with you and you told me what your project was, I was not surprised at all. In fact, it sounded really cool to me (and your project really was!) I feel like one of the biggest “no-no’s” we are taught when entering the healthcare field is “don’t talk politics, don’t talk religion”. As a general guideline, this works because then, no one is “stepping on toes” or crossing boundaries. It is interesting to me that you mention screening for spiritual health as a whole because this to me sounds like a taboo topic in healthcare. BUT, if, like you mention, we want to treat the WHOLE patient, sometimes spiritual health plays a big role in this. I love the different experiences you shared about patients talking to you about spiritual matters, because like you and LA, I have also had patients ask me about religion and spiritual health- because I wear a cross necklace everyday. I tend to shy away from these conversations because there is a voice in the back of my head that says “these conversations aren’t appropriate for the workplace”, but after reading through your project, I now see that there are times where these conversations can be constructive and appropriate! This was a really great project and I will definitely try harder to incorporate this information in my future practice to ensure holistic care of my patients!
Mike McMorris
Matt,
Even as a guy about to enter seminary, I was skeptical when first hearing your capstone idea. Primarily this was due to my concern that this topic could make some patients, families, or colleagues feel excluded. Your well researched, thoughtful approach to presenting the questions about spirituality and how this could apply to patient assessment and care were done skillfully. Your proposed screening of spiritual well-being is similar to our current attention to the psychosocial health of a patient — we are not the providers of psychological or social counseling but know issues in these areas affect the whole person. Hence we should ask the patient questions and guide them to the appropriate provider accordingly. Excellent work!!
McMike
Lauren-Austyn Arney
Matt,
It is no surprise to me that the topic of your capstone is rooted in spiritual care, which I know is something you have a deep love/passion for given how rooted you are in your faith. However, I was very surprised to hear about all the personal experiences and interactions you had prior to your capstone with people who did not feel cared for as a “whole”. I think you summed it up beautifully by saying that “It is very possible to be physically cared for without feeling cared for; I think there is more of a need than we realize for this facet of care”. At first, I questioned how you would truly be able to effectively integrate spiritual care into practice given many patients can feel spiritual conversations cross the invisible personal line. However, after reviewing your project I appreciate the detailed consideration you took to “test the waters” and only open up this conversation to people who seem receptive. Additionally, I also think it is most practical that you kept spiritual care generalized rather than narrowed down to a specific religion given the inclusion/reach of your products/interventions will be vastly expanded that way. Through my own personal experience of wearing an “Audience of One” bracelet indicating my faith, I was pulled into many conversations with patients with no real guideline on how or when or if I was even allowed to have those spiritual conversations. For people who have or will have experiences similar to mine and yours, I think you have provided wonderful tools and framework to assist in delivering, optimal whole person care without “stepping on toes” or crossing the professional line. Awesome job!!
Stephanie Casnave
Hi Matt,
You did a great job outlining the impact of intertwining spiritual wellness and patient care. I was surprised to learn about the breadth of research and trials that already exist as this is something that I hadn’t necessarily considered. I was under the impression that it may be crossing into unethical territory due to the vast variability and comfortability individuals have in terms of spirituality, more so because I thought of it as a form of “prying” if you will. I appreciated how you framed it in a way to more so build connections with patients so that you get a better understanding of who they are as a person rather than to talk about their specific religion or spirituality they practice. I too am an advocate for holistic patient care and can recognize the impact of one’s spirituality on their motivation, attitude and views on life, more importantly their quality of life. I also appreciated your inclusion of patient autonomy and ensuring to assess the situation so that you are only discussing these topics with individuals who are willing and open to discuss them to avoid disturbing the therapeutic alliance and focus on what is important to that particular patient. Additionally, referring patients out to individuals such as chaplains or other religious leaders is a great option for individuals who aren’t comfortable talking about these topics or feel like the patient would benefit from more in depth discussions with trained professionals. I can definitely see these discussion as a way of strengthening certain patient relationships and will consider utilizing this questioning on patients who are appropriate. However, depending on the person I am not sure if I would include it in everyone’s subjective evaluation considering it is a very intimate topic. I personally would include this line of questioning in later visits once I’ve established more of a relationship with the patient and have a better idea of how they might respond. Nonetheless, very interesting topic and take on the capstone project. Great job!