Purpose and Objective: Identify a population health patient, assess spiritual needs (based on BSMH SH model), offer ongoing support, collect facts to understand patient’s needs (physical, social, spiritual, etc.), pinpoint core issues and/or challenges, collaborate with stakeholders sharing information and developing a plan.
MARKET: Springfield, OH
CHAPLAIN: Doug Graham (Care timeframe July 2025-Oct.2025)
I’ll call this Pt “Mr. N.” I first met Mr. N on my unit, 3E. A consult was made for him because he wanted to do an advance directive. When I met Mr. N he shared how he was a nurse for Mercy Health. Due to his bad health he can’t work anymore. Mr. N has lots of medical needs. He has cancer throughout his body. He expressed his hope in God and peace with dying. He tearfully shared his pain and his inability to do his normal work and have a regular routine. Mr. N is a 60 year old white male who has a girlfriend. He finds meaning in God. He shared how his illness is bringing him closer to God. He expressed how he suffers on a daily basis. He conveyed how he sometimes struggles with God on why he has cancer. He is anxious over the many upcoming treatments he will need as well as the concern of not knowing how his health will, or will not progress. He enjoys talking with me and he expressed how much he appreciated my visit and my listening ear.
Explore their spiritual/emotional/social needs and/or concerns: Document the specific spiritual issues that the patient presented with. Is there any lack of connection God, family/social, self, nature, etc.? What struggles/challenges are they sharing regarding their health and ability to care for themselves? Are any of these potential risks that can make the patient seek readmission to the hospital? Do they need additional education on care, medication, etc.? What else can you infer from what the patient is sharing?
Mr. N expressed struggling spiritually with some doubts mainly due to his cancer. He would share how he deals with the “why” question. Why me? Why cancer? But over the course of our time together he always expresses how much he feels closer to God due to our conversations. He doesn’t feel a lack of connection with God. He is just struggling with having cancer. He shares about his struggles with not being able to work or go many places. He deals with being sick most days. He is able to care for himself somewhat but sometimes needs support. He has a girlfriend who helps him. I think he has a lot of support with his doctors and his girlfriend so his risk of readmission is low. Mr. N is knowledgeable of his condition. He was giving me an education on the type of treatment he receives and how the medicine affects him. He struggles with the chemo. He needs a bone marrow transplant.
Mr. N is praying for healing but is also trusting in God’s will and God’s plan. Mr. N is at peace with God, but still trying to be at peace with his cancer. He wants the peace “of God” in this condition. Mr. N focuses on living life to the fullest and listening to Christina radio.
What helped Mr. N recently is understanding the verse that says, “by His stripes we are healed.” He understands this is not only physical healing but also spiritual healing. He knows ultimate healing is in heaven. He shared with me what is called a CAR-T article, which is about how blood genes are filtered and how this treatment starves cancer.
Mr. N gave himself a LEVEL 3 when asked to rate his level of emotional/spiritual distress. He finds comfort in prayer. Mr. N said his perspective on life and death is changing with more faith, he wanted prayer and enjoys the TeleChalpaincy service. He mentioned how much this service has meant to him by saying its been a blessing and you have helped me more than you know.
Spiritual Intervention:
Describe the spiritual care intervention: Detail the specific actions taken to address the patient’s spiritual needs. This could involve your own visits, connection with clergy, participation in religious practices, or other relevant interventions. How do you facilitate the patient connecting to their sources of meaning/purpose? How do you connect to the care team to share what you discover that impacts patient’s health and care.
I first met Mr. N by helping him to complete his advance directives. That conversation went very well and it led to his desire to receive Tele Chaplaincy. It was clear that he needed and wanted additional support after he was discharged. Mr. N expressed his doubts and fears due to having cancer. I provided emotional and spiritual care through empathetic listening and showing him unconditional positive regard. This helped Mr. N to give voice to his pain and not feel judged. He had a lot to share. He didn’t realize it at the time but through our discussion he was processing his pain and situation. This is how he realized his need for on-going care. He expressed feeling closer to God as a result. I offered prayer and I gave him a wooden cross as a reminder of God’s love and presence.
When I would call Mr. N he was always glad for us to talk. He expressed how much me calling him helped him. I often invite him to share his pain and struggle. I encourage him to share how his faith is impacting his life and how his health condition is affecting his faith. By giving him emotional space to share his story he found hope and peace. He expressed how he feels closer to God and how he has a better mental perspective on his situation and how he finds meaning. He also enjoys our time of prayer together.
After each visit I document on the encounter and make notes. I also use our smart phrases to give an additional assessment of Mr. N. This documentation is a way to communicate to the rest of his care team and keep them informed of his progress.
I messaged two of Mr. N’s doctors, asking them if they have seen any difference in their patient because of my emotional/spiritual support. Both got back with me. Here are their responses:
Dr.#1 – “Thank you for your services. He appears more calm and is able to understand the underlying situation with more clarity. I surely see an improvement in his mental and physical health. Thanks again”
Dr. #2 – “Doug, Thanks for reaching out. In my experience with Nick I have found that he has become more at peace with his diagnosis and is finding comfort in understanding the “next steps” in his treatment plan. The last visit that I had with him he did speak about his sessions with you and how his faith overall has been a source of comfort that has allowed him to appreciate the many sources of support that have surrounded him. Given how devastated he was initially and the speed with which he transitioned to a more positive outlook I would say that your services have made a significant impact. I hope this helps.”
Impact of the Intervention:
Patient perspective: Describe how the spiritual care intervention was received by the patient and how they felt it impacted their well-being.
Mr. N has told me many times how much he appreciates my spiritual care. He has mentioned that my empathetic listening has allowed him to be himself, express his pain, and process how he wants to live. He has mentioned how my encouraging words, my non-judgment presence, and my spiritual support has caused him to draw closer to God. He has found a better connection to God and family. He feels God is using his cancer for a higher purpose. He has also expressed how he feels like a person of worth and is treated with dignity. Lastly, he feels more peace as a result of our time together and he wishes to continue outpatient spiritual care.
Review the medical record: Analyze the patient’s medical record to determine if there were any discernible impacts on their overall health as a result of the spiritual care. (Outcomes Manager)
From his medical records I can see that his risk of readmission level has gone down. It’s still high but it did go down. His number went from 96% to 91%. He is doing a lot of office visits recently and less hospital visits. From his record it appears he is eating better. He has no had a visit to the ED in 2 months. He is still battling cancer. That’s not improving. He still takes heavy pain meds. He has better support with home health care visits, has has a social worker for support, he has solid financial support and insurance, his girlfriend is helping him, he is able to get to his appointments, he has his advance directives, and he enjoys TeleChaplaincy. Mr. N is very appreciative of outreaches and resources, he states he is remaining positive throughout treatment. Mr. N states from his record that his big barriers are managing pain, stress, and dealing with the side affects of the medicine.
Mr. N also mentioned having some anxiety due to his cancer treatments. When I last assessed his emotional and spiritual distress he gave himself a level 3. This is down from a previous encounter where he gave himself a 7. I am still tracking Mr. N’s progress and assessing his progress. I will sometimes use a scale of 1-10 (10 being high distress) to ask him to rate his distress level. I have also used a simple model of; mild, moderate, or high to measure the depth of his distress. In my assessment he has gone from high to moderate. Mr. N has told me that he credits TeleChaplaincy for his spiritual and emotional improvement.
Reflect on the Findings:
Explore the effectiveness: Discuss whether the intervention was deemed effective in addressing the patient’s spiritual needs and how this was assessed.
I believe my interventions have been affective in supporting Mr. N. I think the ministry of presence via phone calls have helped him a lot. He is able to vocalize his concerns and worries. He feels the support and often comments on how he is benefiting from my care. I think giving him emotional support has also allowed him to vent his fears and frustrations. Our visits give him the space to process how he wants to move forward. The spiritual assessment I do for him has also served as a way to track his progress. He is still dealing with cancer but his distress level has gone down from a 7 to a 3. He has expressed how our prayer time is also a blessing to him. And he has mentioned how my care has helped him to reframe his perspective on suffering. He has expressed more hope and meaning as a result of TeleChaplaincy.
Consider the broader implications: Reflect on the potential benefits of integrating spiritual care into care management for both patients and the care team.
Mr. N has mentioned how he sees how Mercy Health is a wholistic ministry. He is a nurse so he already knows this, but he appreciates how we don’t just treat the body. He appreciates how we address his emotional and spiritual needs as well. And he has mentioned to me that my care is not “pushy.” He used this phrase to say that I don’t push religion, but I do care for him according to his spiritual needs. He knows I’m not there to just pray or push religion. He knows I’m there to provide spiritual assessment, give emotional and spiritual support, to be his advocate, to provide empathetic listening, to track his care and help him to find meaning despite his medical condition.
Highlight lessons learned: Identify any challenges or lessons learned from the case study that could inform future integration of spiritual health services in Pop Health.
I think trying to collaborate with other members of his care team would be a new goal of mine. I think the challenge there is many doctor’s focus solely on the body and their medical field of study. They tend to trust us as chaplains to give emotional and spiritual support, but they may not see the value of us talking together. I would want to explore this aspect of patient care more in the future.
As far as my care is concerned, I have learned how to be a more in-depth chaplain through TeleChaplaincy. For example, as a chaplain I mainly see patients in the hospital and even though each visit is separate and unique, the patient usually only receives one visit from me before they are discharged. That one visit may touch on the main areas of care like support, assessment, empathetic listening and presence, prayer and emotional and spiritual support, but with TeleChaplaincy it has caused me to “dig deeper.” With TeleChaplaincy I will meet with a patient 3-4 times. And each time the patient shares more of their story. Their story then brings up more topics of concern and more needs to address. This has been a good thing for my personal growth as a chaplain. It is causing me to be more knowledgeable and more aware of the various issues that patients are dealing with. It has also forced me to use more interventions when necessary. I also use more board certified competencies to address most of those needs. Some of the competencies I feel I have gone deeper into would include:
- Establish, deepen, and conclude pastoral relationships with sensitivity, openness, and respect.
- Use listening, empathy, and crisis intervention skills to address spiritual distress, grief, and loss.
- Conduct spiritual assessments and develop a care plan that addresses identified needs.
- Evaluate the outcomes of care and adapt interventions as needed.
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