Free book - Meditations on Chaplaincy and Spiritual Care

https://chaplaincyinnovation.org/wp-content/uploads/2020/05/Meditations-on-Chaplaincy-and-Spiritual-Care.pdf

Spiritual Care at the Front Lines of the Pandemic

Spiritual Care at the Front Lines of the Pandemic By Jenna Barnett May 6, 2020 Fifteen years ago, if someone was dying inside Duke Raleigh Hospital, medical staff would run to the overhead PA system to ask, “Is there a pastor anywhere in the hospital?” Back then, the hospital didn’t have a spiritual care program. Today, as COVID-19 pushes hospitals toward capacity, chaplains are essential — at least according to Rev. Amy Canosa, a clinical pastoral educator and chaplain at Duke Raleigh Hospital. In a typical work week, members of her spiritual care team spend about 70 percent of their time attending to patients and 30 percent offering care to staff. COVID-19 has nearly flipped that ratio. The chaplains wear masks and have their temperatures checked upon arrival so that they can continue to safely care for both patients and staff. On the day I interviewed Canosa, she had just finished praying for a few staff members after they expressed a need for her to ask God for some hope, and for this to end. Four women gathered, and Canosa offered up a prayer that — as best she can remember — sounded something like this: God you’re hearing your children who are showing up to work every day and seeking to be faithful. God we are tired. And we are worried about our loved ones. And we’re worried about the people in this place. And we need some hope. And we need you to show up in ways that we can see. And we need you to help us see the ways in which you are already present, even now. Because God, it is so hard to see you sometimes in the midst of what’s happening. So help give us signs and symbols to help us feel that we are not alone. Canosa put together a “Chaplain Compassion Cart” full of things that she hopes might bring staff comfort — paper mache flowers, lavender aromatherapy balls, worry stones — and she posted a bulletin board that offers resources and asks staff to share, “In this time of COVID-19, what is getting you through?” Doctors and nurses have Sharpied in answers ranging from prayer and family to “Tiger King” and red wine. Canosa sees her job as both ministry and hospitality: At times she’s offering water to loved ones awaiting scary news, at other times she’s giving patients permission to be mad at God. And in these pandemic days of visitor restrictions, Canosa has also played the part of tech support, teaching an 85-year-old-patient how to FaceTime her grandson. In many ways, COVID-19 has pushed the spiritual care team to be nimble and creative, as doctors and nurses are pressed to the limits and don’t have the time or training to take on the added emotional burden. “We walk in when everyone else is ready to walk out,” Canosa said. “Doctors didn’t get trained to do all that emotional work. And the reality is they have to numb themselves to some of these feelings in order to do their job.” But chaplaincy isn’t just about compassion, Canosa says, though that’s essential. It’s also about health outcomes. Stress is linked, for instance, to prolonged recovery periods and decreased pain thresholds. “When there’s a code blue or a stroke — when there’s pandemonium and crisis — everyone goes running,” Canosa said. “We joke that chaplains don’t run. Part of what we do is offer that calm and compassionate presence.” ‘Now is not the time for perfection’ Since 2018, Alyssa Adreani, the manager for the Department of Spiritual Care at Newton-Wellesley Hospital, has kept a Post-It Note on her desk that reads, “compassionate, non-anxious presence” — a daily reminder of what she wants her interfaith chaplaincy to look like. But once the coronavirus grabbed hold of her hospital in the Boston suburbs, she made a slight revision. “Right now our role is often to provide a compassionate less-anxious presence,” she said. “What I am telling other people, I am telling myself: Now is not the time for perfection.” But she’s still learning what that less-anxious presence looks like when it comes to spiritual care within the chaos of a pandemic. “These clinicians are responding to terrible trauma,” Adreani said. “A lot of people have likened our situation to nurses being on a battlefield.” So she wanted to learn from a spiritual care provider with war-zone experience. The Chaplaincy Innovation Lab, which facilitates conversation between chaplaincy leaders, theological educators, clinical educators, and social scientists, connected her with Andrew Shriver, an Army chaplain, via phone. Shriver told her that spiritual care in times like these can look quite casual — like gently showing up. It looks like following up with staff and making yourself available. Nurses and doctors usually don’t have time for a heart-to-heart when they’re on the clock. “For clinical staff, there’s a level of functional compartmentalization.” Adreani said. They just need to get through the task in front of them. “And if [they] break stride, [they] won’t be able to get through the day. And so I want staff to know that they have my support on their terms. Not on my terms.” As doctors, nurses, and other frontline health care workers throughout the country see increased workloads, chaplains adjust with off-hours support, offering cell numbers and social media inboxes. Practicing presence via Zoom Right now at Duke Raleigh Hospital, visitors are only allowed to visit patients during end-of-life situations, one guest at a time. “Chaplains are the ones walking in with a phone so that loved ones can convey love and care,” Canosa said. But in other hospitals across the country and world, the regulations are more stringent: Chaplains don’t have an opportunity to be in patients’ rooms at all, a huge obstacle for a person whose primary goal is to offer active presence. Tele-chaplaincy has played a role in spiritual care for years, especially for immune-compromised patients, but the highly contagious coronavirus has proliferated the practice. So what does active presence look like via Zoom or cellphone? In March, when it was becoming clear that tele-chaplaincy would have to replace in-person care in many situations, the Chaplaincy Innovation Lab put together a virtual town hall to brainstorm. About 1,200 spiritual care providers signed up for the Zoom call, where they learned scripts that might help facilitate intimacy in the absence of physical presence. These scripts help communicate that they’re available to offer care, regardless of the patient’s faith background. For instance: One of the things that I am here for is spiritual support. That can mean different things for different people. Sometimes it means supporting people in a certain religion and praying for them. Sometimes it means helping them connect to their meaning and purpose, but not a certain religion. Are you of a certain religious or spiritual orientation? According to Canosa, tele-chaplaincy can’t replicate the connections formed from sitting in the same room, but at times, the medium can foster a certain anonymity that gives patients and the loved ones of patients permission to be more vulnerable. She likened it to the Catholic confessional set-up. “Because people can’t see us, there’s that freedom of being more emotionally intimate,” she said. “If I can’t see you, I can pour out a little bit more.” That being said, both Canosa and Adreani believe tele-chaplaincy is ultimately less impactful than in-person care. Silence over the phone feels different than silence in a hospital room. Hand holding during prayer is impossible. “But this is so much better than nothing,” Canosa added. “I can’t imagine nothing. Your loved one dying and no one reaching out. And no one offering any care. And no one checking in. So while this isn’t the active presence I would want, this is still a gift.” Chaplaincy in the time of COVID-19 is about figuring out what “good-enough” care looks like, Canosa explained. This is a loaves-and-fish scenario, she added, invoking the story in the Gospels in which Jesus feeds the multitudes with just a few rations. The disciples look at the bread and say “there’s no way we can feed all these folks!” Canosa said. “It may not be a four-course meal, but we can feed people, if we have the faith and the imagination to do that kind of work.” Jenna Barnett Jenna Barnett is an Associate Web Editor for Sojourners.

Encountering Grief: a 10 minute guided meditation with Roshi Joan Halifax

A very helpful guided meditation on grief. https://www.youtube.com/watch?v=TGhHV1ZdcL8

A Simple Guide to Self-Care

Check out this article in The Atlantic on self-care https://www.theatlantic.com/health/archive/2015/10/internet-self-care/408580/

"Tiny Buddha" Self-care Practices for mind, body and soul

This website has lots of great ideas to care for self. https://tinybuddha.com/blog/45-simple-self-care-practices-for-a-healthy-mind-body-and-soul/

Aligning with Love from SDI: a spiritual practice

ALIGNING WITH LOVE This month Passover, Good Friday and Easter all took place as the world slipped further into a profound health and economic crisis. Around the world, we understandably struggle to recognize the relationship of loss and renewal in this pandemic. This simple practice is about grounding ourselves - and refreshing ourselves - in that which transcends all limitations, the creative force of the universe, love. PRACTICE 1) Find a safe and warm place. Welcome stillness. Greet all thoughts as old friends. But tell them - Maybe another day. Tell them today you need to make space for another old friend right now..... When you feel ready, welcome God, or however you name the ground of all being. 2) Read this prayer. Then close your eyes, and say it in your own words. Change anything you like. Just honour what arises deep within you as you read it: PRAYER "I will always keep trying. I will never give up. I will be present with you, God, and with all beings. In every moment. This is my intention. I will be grateful for all you give, God. I will be grateful for all I experience. I will be grateful in every moment. I will make of my heart an open window to shine your love and light. I will make of my life an open window to share your love and light. I will make of my soul an open window to be your love and light. This is enough. This is abundance. To shine, share and be your love and light. To shine, share and be the love and light inherent in all beings. I will acknowledge - and let go - all negativity I create and carry. I will align with love. I will align with love. I will align with love. And like the prodigal son, I will feel the wonder and joy of coming home to you, God, and being accepted as I am. No matter how far I stray, no matter how often I stray, I will return home. Your infinite welcome calls me. And I will infinitely respond. I will choose love. I do choose love. I am love. And love never ends." Peace to you all, brothers and sisters. Blessings to you in all you do.

Caring for Those Who Care - a link to an on-line resource

https://chaplaincyinnovation.org/wp-content/uploads/2020/04/Staff-care-eBook-042220-SD-for-Final-with-MS-links-updated.pdf

Grief, Dying and Death during a Pandemic

http://www.wellbeingwaterloo.ca/blog/grief-dying-and-death-during-a-pandemic/

Caring for Self and Others in Times of Trboule: Some Spiritual Tools and tips

Caring for Self and Others in Times of Trouble: Some Spiritual Tools and Tips 1. Breathe. Breathe. Breathe some more. Take time in your day, at any moment, to take ten deep even breaths. Carve out 5-10 minutes to meditate or practice mindfulness or contemplative prayer. Start here, now, wherever you are. 2. Ground yourself in the present moment. Focus your awareness on something real, enduring, or beautiful in your surroundings. Look up often. Discover the wonder and awe that is already here. 3. Acknowledge your fears, anxieties, concerns. Offer them up in prayer, if you pray. Write them in your journal. Share them with others. Feel what you feel, honor it, and know that it is not the final word. 4. Remember you are not alone. Ever. You are surrounded by care and support. Reach out. 5. Create and sustain community. Show up for one another. Listen compassionately. Practice empathy. Even while avoiding “close physical contact,” message the people you care about. Stand with those most vulnerable and those who suffer the brunt of prejudice and fear. Check in on folks. Call your mother, father, guardian, mentor, little sibling, long-lost friend. 6. Unplug, judiciously. While staying aware of developments, do not let the Corona-chaos govern you, but forgive yourself when and if it does. 7. Practice kindness. There is a temptation in health scares to view others as potential threats. Remember we are in this together. While practicing health guidelines and appropriate caution, remember to engage one another. Smile when you can. Bring good deeds and good energy into our world. 8. Stay healthy through sleep, diet, exercise. See healing and wellness holistically—mind, body, and spirit. 9. Make art. Discover, imagine, engage your hopes and fears, the beauty and ugliness of our world. Write, paint, sing, dance, soar. 10. Practice gratitude. In the face of crises, make note of the things for which you are grateful: your breath, the particular shade of the sky at dusk—or dawn. The color blue, the color green, the gifts and strengths you have, other people in your life, the ability to laugh. A pet. 11. Connect with your spiritual, religious, humanist, cultural, or other communities. Find strength and solace and power in traditions, texts, rituals, practices, holy times and seasons. 12. Pray as you are able, silently, through song, in readings, through ancestors. Remember the long view of history, the rhythms and cycles of nature, the invisible threads that connect us all. 13. Practice hope. Trust in the future and our power to endure and persist, to live fully into the goodness that awaits. —Alexander Levering Kern Director of the Center for Spirituality, Dialogue, and Service Northeastern University March 11, 2020

Three Wishes for post- COVID-19 health care - article

John A. Hovanesian, MD, FACS, focuses his blog on new technologies and innovations and how ophthalmic practices can best incorporate them to benefit patients. BLOG: Three wishes for post-COVID-19 health care April 14, 2020 So many frustrating unknowns surround us in this health care crisis. Whether we are a doctor or a staff member, an industry employee or a researcher, at this writing we have no real idea how much our loved ones might suffer, when we will return to work and how government subsidies will help us support our families and our employees. But like those who lived through the Great Depression, we are quickly learning lessons in resilience that will color the rest of our lives. Without knowing the rest of this story, I do know what I wish for in the post-COVID-19 world: COVID-19 is impacting health care professionals’ information needs COVID-19: Limited health care access further divides ‘haves’ from ‘have-nots’ AHA updates CPR guidelines to address patients with COVID-19 Leaner, more efficient practices and drug/device makers and a quick economic recovery. Buoyed by patients with pent-up demand for our services combined with workforce streamlining from natural attrition, we will all perform with the bare necessities. We will work harder and longer. This summer, if we are back to work by then, will bring few vacations, but in the wake of the worst financial impact of our professional lives, practices and suppliers of drugs and devices will spring back quickly to health. And to think just a few months ago we were worried about reductions in reimbursement. Those will still be a challenge, but we have overcome so much more. Virtual care will be here to stay. By the time this issue of Ocular Surgery News reaches mailboxes, most of our colleagues will have tried telemedicine to perform some level of service for patients. Most of us who have already tried have become quite pleased with how much good doctoring can be done, even without our diagnostic instruments. The world will know that patients deserve to see our faces and hear our reassuring voices without leaving home. Elimination of COVID-19 will not eliminate the viability of virtual care but enhance its possibilities. Smart industry players will bring us better tools that integrate better with our EHR systems, automate billing and allow solid documentation of services performed. We will all learn the meaning of quality time. Having our schedules cleared is now giving us more time with loved ones, more time with pets, more time for exercise and more time for personal reflection. We will become closer to family and friends who are farther away. We will understand that a full schedule does not mean a full life and that we don’t need to be “the richest guy in the graveyard.” Travel will still be exciting, but so will be looking out the window, enjoying a warm drink. We will be able to laugh at adversity we can’t control and help neighbors through the difficulties that we can. We will return to work with the right priorities, a clearer sense of purpose and a kinder approach to our patients and staff, whom we will appreciate more than ever. The outcome of many of these wishes we can’t control, but the measure of our wisdom may lie in how we use this time to shape the quality of our future. We can be simply reactive, reading and getting absorbed in the news, or we can be proactive, using our downtime to recalibrate our life compass. Whatever your wishes for the post-COVID-19 world, I hope you too are doing what you can to make them come true.

Why am I so Tired? an article

https://parasolwellness.com/why-am-i-so-tired/?

Caring Community on CASC website

For CASC members: Login to view:
https://spiritualcare.ca/members/caring-community/

Grief is the Response to loss of something meaningful - from the Centre for Complicated Grief

From the following article:
https://complicatedgrief.columbia.edu/professionals/complicated-grief-professionals/overview/

"Grief is the response to loss of something meaningful Grief is the natural response to losing a loved one. Most people don’t need grief therapists, even when the loss is sudden and unexpected and very, very sad. People have natural ways of adapting to attachment loss, usually with the support of friends and relatives, and everyone does it in their own way. You can think of healing after loss as analogous to healing after a physical wound. The loss, like the injury, triggers a pain response which can be very strong. Injuries also activate a healing process. Loss does too. However, a wound complication, like an infection, can interfere with healing. So, too, maladaptive thoughts, dysfunctional behaviors or inadequate emotion regulation can interfere with adaptation to loss.

CG is not less likely after loss of a rewarding relationship Mental health training does not usually include learning about the syndrome of complicated grief. However, trainees often are taught that grief is complicated if there was an ambivalent relationship to the person who died. This is a misconception. Adapting to a loss is more difficult if a person can imagine how things could have been different. People might do this because the relationship was conflictual. However, this is uncommon. Most people with complicated grief have had an especially strong and rewarding relationship to the person who died.

Key definitions
 Grief is the response to loss that contains thoughts, behaviors, emotions and physiological changed; if the loss is permanent, so too is the grief, but its form evolves and changes as a person adapts to the loss

Acute grief occurs in the early period after a loss and often dominates the life of a bereaved person; strong feelings of yearning, longing and sorrow are typical as are insistent thoughts and memories of the person who died. Other painful emotions, including anxiety, anger, remorse, guilt or shame are also common. Activities are often focused on doing or not doing things to try to deal with the loss.

Integrated grief is the lasting form of grief in which loss-related thoughts, feelings and behaviors are integrated into a bereaved person’s ongoing functioning; grief has a place in the person’s life without dominating.

Complicated grief is a persistent form of intense grief in which maladaptive thoughts and dysfunctional behaviors are present along with continued yearning, longing and sadness and/or preoccupation with thoughts and memories of the person who died. Grief continues to dominate life and the future seems bleak and empty. Irrational thoughts that the deceased person might reappear are common and the bereaved person feels lost and alone.

Adapting to loss entails accepting the reality of the death, including its finality, consequences and changed relationship to the person who died; adapting means seeing the future as holding possibilities for a life with purpose and meaning, joy and satisfaction.

 Examples of Grief “Complications”

Maladaptive thoughts are typically counterfactual, grief-focused or catastrophizing; its natural to second guess a loved one’s death, especially if it was sudden, unexpected or untimely; most people worry about whether they are grieving in “the right way” and many dread the future in a world without their deceased loved one. People with complicated grief ruminate over these kinds of thoughts.

Dysfunctional behaviors are typically related to avoiding reminders of the loss and/or escaping from the painful reality. A bereaved person may try to feel close to the person who died through sensory stimulation and day dreaming about being with them – looking at pictures, listening to their voice, smelling their clothes, trying to recall what it was like to be together. Bereaved people are often inclined to avoid places, people or activities that hold reminders of the person who died. These behaviors are problematic when they become the only way of managing painful emotions.

Inadequate emotion regulation is another common problem for people with complicated grief. Acute grief is typically highly emotional. Most people have a range of ways to regulate these emotions. They balance the pain with periods of respite, giving themselves permission to set the grief aside for a time. People with complicated grief have trouble doing this; instead, they often focus on things that increase emotional activation. Regular routines including adequate sleep, nourishing meals, adequate exercise and social contacts may be disrupted, making emotions more difficult to manage."

https://complicatedgrief.columbia.edu/professionals/complicated-grief-professionals/overview/