An Extension of Spiritual Care

Services: Healing Radio and Television

Content

2014

Abstract

When patients enter the hospital, their lives and the lives of their loved ones are immediately changed. Patients and families are met with difficult diagnosis, prognosis, decisions, faith challenges and emotions that change their lives forever. The physical environment is often sterile and filled with many loud noises from medical equipment; the medical language is often foreign. While hospitals are created for healing, often times the environment seems contrary to the healing process. Patients often report a lack of attention to their spiritual care needs and note the need for having a more healing space. Can hospitals create a more healing environment through the use of television/radio programming that meets the spiritual care and faith based needs of its diverse population and as a result, impact patient satisfaction rates and shortens patients’ length of stay?

Abstract - Purpose of Study

The purpose of this study is to determine if spiritual care support programming has any impact on patient satisfaction and length of stay. (Bahlhorn, 2013) The methods used to collect the data were a survey delivered online and hard copies at patient bedside. The results showed an increase in patient satisfaction. Length of stay could not be determined in this study. Further studies on specific programming and its impact on certain health conditions and a lengthier study on patient length of might be the focus of further studies as this project continues to evolve.

Definition of Terms

• Patient Satisfaction- Patients report how their stay went throughout their stay to various members of the team, specifically to the Chaplains who visit them and post hospital stay via “Patient Satisfaction Survey”.

• CCTV - Closed Circuit Television

• Clinical Pastoral Care Services - Spiritual Care services provided by chaplains in hospitals and other health care facilities throughout the United States. These services operate under federal hospital guidelines as well as National Certification from Certifying Bodies such as Board Certified Chaplains, National Association of Catholic Chaplains and National Association of Jewish Chaplains.

• Healing Space – A designated space where healing can occur. The space may have various contributors that define it as a healing space. In the hospital healing space is also created when patients receive physical, mental and spiritual care

Definition of Terms

• Spiritual Care – Provided to patients in the form of listening support, ministry of presence, pastoral counseling, facilitation of grief, guiding, providing bereavement resources, providing prayer, rituals, music, meditation, and various other services to patients according to their spiritual needs which are assessed by the Chaplain.

• Healing Content- Music, prayer, ritual, reading materials, art, pictures of nature, encouraging stories, poetry, encouraging quotes, sacred readings

• Recovery time - The time it takes patient to recover from illness, surgery

• Length of stay (LOS) – Length of time patient stays in the hospital

• Patient Satisfaction Rates (PSR)- Measured Patient Satisfaction Scores from collected surveys (Bahlhorn, 2013)

Chaplains…are available for all persons who are:

* Anticipating life changes* Coping with illness or new diagnosis* Seeking prayer support* Desiring Sacramental ministry* Interested in spiritual or emotional support* Preparing for surgery* Experiencing loneliness, emotional distress, grief, anger, fear* Requesting assistance with an Advance Directive Assisting with end of life concerns

JAHCO Standards

“Patients have the fundamental right to receive considerate care that safeguards their personal dignity and respects their cultural,

psychosocial and spiritual values and beliefs.” (The Joint Commission, 2005,pp.6-7)

“ Addressing and supporting patient’s spirituality can only make their health care experiences more positive, but in many cases can

promote health decrease depression, helps patients cope with difficult illness, and even improve outcomes for some patients”

(The Joint Commission, 2005,pp.6-7)

JAHCO Compliance

• Ensure that patients, their families and staff receive education on their rights as we put them into practice in the clinical setting.

• Provide patient’s with access to their spiritual community through professional pastoral care services

• Integrate an extension of care that provides prayers, meditation and other resources that meet the spiritual needs of ALL patients, families appropriate to their care assessed by professional Clinical Pastoral Care Chaplains.

“ Additional standards of professionalism apply in the areas of professional care clinical ethics, bioethics and identity and

conduct” (Collaboration, 2013 pp.1-4)

Board Certified Chaplains

Chaplains are professionally trained through National Certification programs the provide them with education that enables the to respond to the

psychological, social, emotional, spiritual and cultural concerns of patients, their families and staff. Clinical training and broad experience, allows them to

assess the need and develop a plan that works with the plan of care, assessing need for changes on a daily basis or upon referral from other

members of the health care team. Constant communication amongst members of the interdisciplinary team promote best outcomes for patients. Board Certified chaplains receive education Master’s level education and

Clinical training that enables them to work with children and adults.

Certified Music Practitioners

Through the clinical practice of music, Music ministers who are also music therapists work one on one with patients at bedside, closely

watching physical and emotional responses to their therapeutic music, altering the music

according to the individual’s responses so as to reduce anxiety, to assist in restfulness, to bring

comfort even to the point of taking away physical pain.

Creating a Healing Environment

“Being in a hospital should arguably be a time of peace of reflection, because every person in the hospital needs to garner resources to tackle tough times.” (Nanda, 2011)

“A pleasing and positive environment that is presented as a spiritual sanctuary with natural light, gardens, fountains, art and music is enormously beneficial for patient’s well-being.” (Carl PhD., 2013)

“More than 55% of critical care nurses surveyed reported that patient’s and their families most commonly request diet, exercises, relaxation techniques as well as prayer, massage and counseling from their nurse”.

Expected Outcomes

• Measurable Rates of Patient Satisfaction

• Shorter Length of Stay

Spiritual Care Programming Content

• Music

• Poetry

• Prayer

• Sacred Readings

• Meditation

• Photography

• Art

• Encouraging Stories

Literary Review: Music

• Music has been used to promote healing in a variety of settings. McCaffrey (2008)

• Using music to create healing music can help promote mental and physical health and well-being for patients.

• Throughout the ages, music has been used in healing ceremonies, rituals and in teaching.

• Recent studies have shown that in the medical environment, music reduced anxiety and promoted hope which assisted patients in their healing process. Recent pediatric studies have focused on how music might have therapeutic value. (Evans, 2010)

Literary Review: Prayer, Meditation & Sacred Readings

Spiritual care has also been termed in the mind-body connection category. Dossey and fellow scientists conducted a study on how

stress impacts on rats and mice and found that they often died when they were exposed to stressors like electrical shock. They then

concluded that humans who experience stress react in the same way. Dossey (1993) proposed that medicine encompassed three areas. One of these areas included prayer, and more specifically intercessory prayer. (Maier-Lorentz, 2004, pp. 23-32) The author

cites the results of another study conducted by Koenig George and Titus in 2004: “the effects of religion and spirituality in 838 medically ill hospitalized patients’ resulted in decreased depressive symptoms

increased cognitive function and promoted better psychological health.” (Maier-Lorentz, 2004)

Literary Review: Art & Photography

“Art in all its forms provides mechanisms to cope with life’s challenges and to create an atmosphere of healing” (Logid, 2011)

“Arts can promote healing though there be a lack of power to cure, “Art can also represent a respect for the various cultures that come to the hospital. “ Representing the full spectrum of diversity; age, gender, personality, sexual orientation, race/ethnicity, religion; physical/mental abilities; urban/rural, social/political class; and migration/generation…” (Rollins, 2002)

“Exploring unusual ways of presenting information outside the clinical setting may allow the development of new methods of informing emotional as well as intellectual decision-making.” (Lee, 1999).

Literary Review: Encouraging Stories & Poetry

“Compelling storytelling ability may have conferred an evolutionary survival advantage and if so, is likely to represent in the neural circuitry of the human brain.” (Nigum, 2012, pp. 567-571)

Story tellings are powerful means of communicating profound truths in a way that bypasses the ego’s resistance to new ideas-hence their therapeutic value. As the ego relaxes its guard transformational shifts can occur.” (Frankel, 2006, p. 73).

Patient Length of Stay

“ Patient satisfaction is considered to be a major indicator in the evaluation and improvement of quality in health care.(Aharoney & Strausser, 1993) (Hekkert, 2009)

Data Collection

 

25- patients, their family and staff were asked to participate in a blind- survey to provide measurable

feedback on the healing quality of the programming, the informative nature of the programming and whether patients, staff or family felt that this impacted patient

satisfaction rates and shortened patient length of stay.

Data Collection

Surveys were presented to both genders. An age subgroup did not present itself during the survey process, and did not impact the survey results beyond identification. Participants included patients, their families and staff. This participant group encompassed everyone in the hospital, because all patients, families and staff are the patients of chaplains in the hospital. For the purpose of this study, community religious leaders were not included in the hospital study as they might have introduced variables that could bias the study in either direction. Additionally, this is an area of study that may have relevance after programming has aired. Patient nurses, chaplains and volunteer staff collected surveys. Patient Satisfaction surveys that presented with comments that were included as a subgroup. (Bahlhorn, 2013)

Procedure

When presenting the healing programming content to patients they were able to view programming via a dedicated Closed Circuit Television Channel in the Hospital. This channel number may vary in different hospitals. Patients in the hospital were invited to view the content during their stay. Patients in the Emergency Room areas were unable to view the programming. Programming was made available for viewing throughout the hospital and was accessible in all patient rooms that have a working television. (Bahlhorn, 2013)

Background

There are two channels created with a third in development to run for patient, families and staff otherwise known in this study as participants. The first channel is the Hope Channel whose demographics are adults. The second channel is the Giggles Channel and focused on children and their families. Children are ages 0-12.

Data Method

Channel 16, a closed circuit channel at Mercy General Hospital and Methodist Hospital in Sacramento, California are running the pilot and a short 30 minute clip of the program is posted on a private YouTube channel. Additionally Channels 16 and 17 are running the programming at UC Davis Medical Center on their CCTV.

Faith Group Participation

The content is from Several Christian faith traditions (Catholic & Protestant), Buddhist, Hindu, Baha’i, Muslim and Judaism. Several members of the community which include religious leaders, musicians, photographers, artist, children’s community organizations, authors, poets and various others members from other professions contributed their talents for the project.

Data Method - SurveySurvey questions were presented to 25 individuals manually and 12 individuals online through survey monkey. The questions presented in the survey are as follows:

1)Is spiritual care important to you while you are in the hospital?

2) Did you find the program content to be diverse and educational?

3)Did you experience comfort, peace or healing from this programing?

4)Would you continue to listen/watch the program and/or similar programming during your hospital stay?

Each question measured using the Likert Scale as follows: 0- I strongly disagree 1- I somewhat disagree 2- I neither disagree nor agree 3-somewhat agree and 4) I strongly agree.

Analysis – Hope Channel

67% of the total viewing population was patients measured at a value of 55.0. Twenty-Four percent (24 %) of the total viewing population was staff at a value of 20.0. Seven percent (7%) of families viewed the programming content at a value of 5.9. Other viewers that consist of friends viewed the programming at a value of 1.2 or 1%.

Analysis - Giggles Channel

17% of the total viewing population was patients measured at a value of 2.3. Thirty-Three percent (33 %) of the total viewing population was staff at a value of 4.5. Forty-One percent (41%) of families viewed the programming content at a value of 5.5. Other viewers that consist of friends viewed the programming at a value of 1.2 or 9%.

Analysis

On Average the participant viewed the video for 13:11 minutes. The highest percentages of viewing were in the first five to seven minutes and the least amount of viewing time occurred at about 50%. Audience viewed this online and on the CCTV system. Relative audience viewing shows how long the content was viewed.

Question 1 Analysis

This data shows that the program identifies the importance of spiritual care while patients are in the hospital. Survey resulted in 22.22% reporting that they somewhat agreed, 11.11% neither disagreed nor agreed, while the remaining 66.67% strongly agreed. Spiritual care services are currently mandated by JACHO accrediting agency throughout the United States as it applies to hospital systems.

Question 2 Analysis

This data shows that the program identifies the importance of spiritual care while patients are in the hospital. Survey resulted in 55.56% reporting that they somewhat agreed while the remaining 44.47% strongly agreed.

Question 3 Analysis

This data shows that the program identifies the importance of spiritual care while patients are in the hospital. Survey resulted in 33.33% reporting that they somewhat agreed while the remaining 66.67% strongly agreed.

Question 4 Analysis

This data shows that the program identifies the importance of spiritual care while patients are in the hospital. Survey resulted in 33.33% reporting that they somewhat agreed while the remaining 66.67% strongly agreed.

Data Summary Analysis

This data shows that the program identifies the importance of spiritual care, the impact it has on the viewer, the desire for similar programming and whether or not it resulted in creating a peaceful environment where patients reported increased satisfaction. Results did not have anyone reporting strongly agree or disagree and somewhat agree nor disagree. The results of this test show that the programming content was received well, receiving satisfaction scores.

Results

• Significant increase of patient satisfaction,

• Increased feedback on content and an open discussion that included

how all who provide care in the clinical environment might contribute

to the spiritual care provided in the hospitals.

• For chaplains and professional clinical pastoral service providers,

increased education on patient’s services, patient rights and ethical

consideration were provided alongside the art, music, stories,

photographs, prayers and sacred readings as an extension of

spiritual care services.

Results

• Programming continued to run at UC Davis Medical Center, Mercy

Methodist and Mercy General Hospitals in Sacramento, California

• Surveys will continue as needed to develop the project while

creating a more healing environment that patients are satisfied with.

• Survey results will be presented at a Multi-disciplinary conference in

collaboration with a neurologist who has studied the impact of music

on the human brain. The conference is being held at The UC Davis

Mind Institute in October 2014

Future of Programming in the Hospital Setting

The project is continuing to grow and develop within the health care setting as healthcare teams across the world

synergize efforts to create healing environments that provide for the whole patient body, mind and spirit. As a

result of this study, the following channels have been requested and/or are in development.

Labor & Delivery Channel(Requested Channel)

This channel provides programming content that is hopeful, includes relaxation techniques, breathing meditations,

sounds of nature, relaxing music hopeful prayers and poetry.

Cardiac Channel

The purpose of this channel will be to provide programming content to our cardiac patients using clinical research studies

outcomes.

Certain rhythms have been studied and have shown that slow, more even rhythms attribute to patient’s health promoting

regulation of heart rate versus music that has erratic or rapid, uneven rhythms.

Neuro Channel

“Modern neuroscience is highly complex and precisely organized stimulus that interacts with the human brain and modulates synaptic plasticity and neuronal learning/readjustment in the brain. For the human brain to process musical stimuli, a substantial proportion of the cortical mantle and several neural networks-rivaling the breadth and complexity of the language system needs to be engaged. Music can elicit different emotions depending on the area of the brain in which it is being processed.” (Lin, 2011, pp. 34-46)

There are 10 areas of the brain that respond to music stimuli recorded in the study conducted by Harvard Review (2011). There are also behavioral responses which occur in three areas of the brain. Some visible and measurable responses in patients include relaxation, decrease of pain, effects on blood pressure, respiratory and heart rates. Another physical response to music has been well documented in studies on the heart rate. (Lin, 2011)

Neuro Channel

The programming content for this channel will include music, prayer, nature, art, stories and meditations that have been the subject of research with significant measurable results.

One particular element of the programming will institute certain musical tones which have been researched and

shown to benefit patient’s who are in comas, have sustained brain injury, stroke or trauma.

Hospice

For our patient’s who are dying, there is no need for continued education on hospital services. This channel will provide programming content that includes relaxing images, prayer, music, encourages life review, relaxation techniques

and letting go of anger, fear or resentment meditations.

An Extension of Spiritual Care Services:

Healing Radio and Television Content

2014

QUESTIONS?

Tamara Bahlhorntammybahlhorn@yahoo.com

(916) 717-4166

BibliographyBahlhorn, T. (2013, October 8). Literature Review. (T. Bahlhorn, Interviewer)

Collaboration, B. o. (2013). Common Standards for Professional Chaplaincy. pages 1-4.

Conrad, Carl. (2010). The Art of Medicine:. The Lancet Music for healing: from magic to medicine, Volume 376 pages 1980-1981.

Dusek, J. A. (2003). Healing Prayer Outcomes Studies. Alternative Therapies, Vol.9, No.3 pages A44-A53.

Elkins, M. B. (2004). Developing a Plan for Pediatric Spiritual Care. Holistic Nursing practice , Volume 18, No. 4, pages 179-184.

Ferguson, T. (2013, October 15). Creating Healing Environments with Evidence-Based Design. Orange County,, California, USA.

Frankel, E. (2006). Stories that Heal the Soul. TIKKUN.org, Volume 21. Chapter 3 page 73.

Bibliography

Hekkert, K. C. (2009). Patient Satisfaction revisited: A multilevel approach. Social Science & Medicine, Volume 69, pages 68-75.

Lee, E. M. (1999). Inside Out: Visual art and emotional decision-making in medicine. Health Expectations, Volume 2 pages 141-146.

Logid, J. M. (2011). The Healing Power of Art: Is it Just for Patients? Creative Nursing, Volume 17, No. 3 pages 118-119.

Maier-Lorentz, M. M. (2004). The importance of Prayer forMind/Body Healing. Nursing Forum, VOlume 39,no.3 pages 23-32.

McCaffrey, R. D. (2008). Music Listening: it's effects on Creating a Healing Environment. Journal od Psychosocial Nursing, Volume 46, No. 10 pages 39-41.

Nanda, U. P. (2011). It's All About Healing. HERD, Volume 4, No. 3 pages 3-6.

Bibliography

Nigum, S. A. (2012). The storytelling Brain. Sci Eng Ethics, Volume 18 pages 567-571.

Rollins, J. R. (2002). Art is the Heart: A Pallet of Possibilities for Healing. Pediatric Nursing , Volume 28 No. 4 pages 354-365.

The Joint Commission. (2005). Evaluating your Spiritual Assessment Process. The Joint Commission: The Source, Volume 3, Issue 2 pages 6-7.

Sample Program Slides

ADVANCE HEALTH CARE DIRECTIVE

Because, it matters that your voice is heard...

One of the biggest gifts that you can give your family, is the gift of clarity

about your health wishes. In the event that you ever become unable to

communicate your medical wishes to your healthcare team, an Advance

Health Care Directive enables you to clearly state your intentions, your

values, and who you would like to speak on your behalf.

ADVANCE HEALTH CARE DIRECTIVE

Because, it matters that your voice is heard...

To receive more information about the Advance Health Care Directive, please notify your nurse to page a chaplain, or leave a message for

the chaplain by calling (916) 453-4655.

Chaplains are available for all persons who are:

* Preparing for surgery* Experiencing loneliness, emotional distress, grief, anger, fear* Requesting assistance with an Advance Directive Assisting with end of life concerns

Chaplains…

APRIL 2014Sunday Monday Tuesday Wednesday Thursday Friday Saturday

1 2 3 4 5

6 7 8 Ramanavami (Hindu)

9 10 11 12 Lazarus Saturday (Orthodox Christianity)

13 Palm Sunday

(All Christians)

Mahavir Jayanti

(Jain)

14 Baisakh New year (Sikh)

15 Lord’s Evening Meal (Jehovah’s Witness)

Hanuman Jayanti (Hindu)

Pesach-Passover

(Judaism)

16 Pesach –Passover (Judaism)

17 Maundy (Holy) Thursday (Christian)

Pesach –Passover (Judaism)

18 Good (Holy) Friday (Christian)

Pesach –Passover (Judaism)

19 Pesach –Passover (Judaism)

20 Easter (All Christians)

Pesach –Passover (Judaism)

21 Pesach –Passover (Judaism)

Ridvan- 1st Day (Baha’i)

22 Pesach –Passover ends(Judaism)

23 St. George Day (Christian)

24 25 26

27 Yom HaShoah (Judaism)

28 29 Ridvan-9th Day (Baha’i)

30

Silence is the source of great strength

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Psalm 119:105

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Things won are done, Joy’s soul lies in doing.~ William Shakespeare

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You, yourself, as much as anyone in the entire universe, deserve your love and affection

~Buddha

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Gratitude bestows reverence, allowing us to encounter everyday

epiphanies, those transcendent

moments of awe that change forever how

we experience life and the world.

~ John Milton

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Where I encounter myself, remember my dreams, take

account of my gifts, discover wisdom from my failures,

and joy for my God given talents, this is

sacred space.

T. Gates

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Some hearts understand each

other, even in silence.”

~Yasmin Mogahed

When words fail, music speaks

~ Hans Christian Anderson