3/6/2015. Sandi Hebley RN, CHPN, LMSW

Transcription

1 Sandi Hebley RN, CHPN, LMSW 1. Discuss and define comprehensive assessment 2. Describe a psychosocial assessment 3. Describe a spiritual assessment 4. Describe an initial bereavement assessment Medicare Conditions of Participation: Comprehensive assessment means a thorough evaluation of the patient s physical, psychosocial, emotional and spiritual status related to the terminal illness and related conditions. This includes a thorough evaluation of the family s willingness and capability to care for the patient. 1

2 Hospice and palliative care are intended to be holistic Philosophy Recognition that a patient is more than physical- Dame Dr. Cicely Saunders Physical Emotional Total Pain Social Spiritual Regulatory requirement Requirement for the 4 Core Disciplines on a hospice team Responsibility for meeting all needs, regardless of whether the patient/family accept visits from all disciplines CoP: assessment must identify all needs that must be addressed in order to promote the hospice patient s well-being, comfort, and dignity throughout the dying process. Assessment of patient s physical status and needs Assessment of patient s and family s emotional status and needs Assessment of patient s and family s social relationships and needs Assessment of patient s and family s spiritual status and needs Assessment of anticipated bereavement needs of family 2

3 Don t tell Mama you re from (or she s on) hospice! Explore what the fear is: She ll think we ve given up on her Don t want to take away her hope She ll get depressed and give up She is expecting a miracle We won t know what to say/do when she knows she is dying And she probably already knows Trust your senses: If something doesn t feel right, explore further or bring to IDT One Red Flag might be the person who seems overly upbeat: I m great! Might be avoiding feelings Do you sense anxiety? Who seems stressed? Remember the team Social Worker is still part of the team for this patient, even if (s)he can t visit Ask about emotional history for patient and family members: any history of depression, anxiety, etc. If not known already, ask about Advance Directives Have they had previous hospice experiences- good or bad? Includes patient s/family s emotional needs and social/relationship needs Cover the questions on the assessment documentation form but don t stop there Use open-ended questions Don t start with your own agenda; let them lead and use a soft touch Don t fear silence give them time to begin to share to speak their own truth Remember we can t fix them 3

4 Who is family for this patient? For couples, how long together? How did they meet? (Encourage sharing- start with less emotionally charged question) Who are the hands-on caregivers? Are there family members who are not involved? Who is geographically available/distant? What do they say about relationships within the family? Who gets along and who doesn t? Who fills what roles in the family? Who makes decisions? Is there an MPOA, financial POA? Same general interview guidelines Don t bring an agenda not our job to save them Don t fear silence Don t try to fix them- discourage them from trying to fix each other Use open-ended questions Trust your senses Many of same areas of exploration as psychosocial assessment but from a different perspective Who is family and how do they relate to each other What is their history- relational and religious Red flag of too positive a response What does Spiritual Care mean? Not religious proselytizing- we don t bring an agenda Helping explore issues of Meaning Of pain/suffering Of my (patient s) life Loss of purpose Guilt Because can t attend services of faith community Because of broken relationships Over being a burden Anger- At God, at faith community 4

5 Do they identify with a specific faith? If so, which one? Patient and family the same? How active have they been? What is their perspective on the meaning of pain/suffering? ( God s Will?) Listen for the big Issues: Loss of meaning/purpose Guilt Reconciliation Being a burden Allow them time to speak their own truth (silence) Depending on their faith history, do they want hospice to contact a clergy person of their own faith? How urgently? Priest- If patient appears imminent, do they want Sacrament of the Sick? Rabbi Imam Explore issues of gender Can a person of opposite gender discuss spiritual issues with them? Is the age of one offering spiritual care important? Issue of miracles Does patient expect one? Family? Miracle can happen while on hospice Different kinds of miracles: Healing can occur when curing cannot. What is their perception of support from their identified faith community, if there is one? Do they self-identify any specific spiritual concerns? Is there a willingness of individuals to explore spiritual issues/needs? What support would be meaningful to them? Don t offer prayer, unless they ask for it If they do ask for prayer, don t inject our own faith verbage Don t offer advice or reassurances from our own faith perspective Know it is OK just to BE with them- supportive presence 5

6 Our Greatest Gift by Henri Nouwen Required by regulations Can help team know how to support the patient/family in preparing for the loss Anticipatory Grief Assess the patient too! Grieving the loss of her/his future Grieving all the things she won t get to see/do Is there anyone who already seems overwhelmed by the thought of the loss? Loss history cumulative grief Recency of losses How do they perceive their own grieving? Complicated Grief Complicated grief is an intense and long-lasting form of grief that takes over a person s life Complicated grief is a form of grief that takes hold of a person s mind and won t let go. People with complicated grief often say that they feel stuck. -- Center for Complicated Grief 6

7 Cumulative grief Disenfranchised grief History of not handling losses well History of emotional/mental issues Developmentally delayed folks Evidence of lack of healthy coping skills Evidence of substance use/abuse to cope Verbal expressions of hopelessness, fear of inability to cope, excessive emotionality Presence of young children- especially if adults are not confident how to help the children Even if other disciplines are not allowed to visit, they are still part of the team. IDT is the time to draw on their expertise to assist those who ARE in the home to know how best to help and support our patients and their families. Any questions? 7