Body, Mind … and Spirit

Speaker 1: Most healthcare journeys are an unwelcome interruption into a person's otherwise routine life. And so when there's that interruption, there's a question of, okay, what now? How do I make meaning in this space?

Speaker 2: Welcome back to Until it's Fixed, where we explore new ideas and work underway to make healthcare simpler and more effective for everyone. I'm your host Callie Chamberlain.

Speaker 3: And I'm Dr. Kenny Poole.

Speaker 2: In this episode we'll be digging into the relationship [00:00:30] between spirituality and our health.

Speaker 3: We always talk about how our health is about so much more than just how our bodies function. It's about everything we do and experience and how those things affect us, which means nothing really exists in isolation when it comes to our health, but we often don't talk about spirituality or religion with our doctors.

Speaker 2: And we're gonna talk a little bit more about the reasons behind this and what's being done to encourage more open and transparent conversations so that we can feel [00:01:00] comfortable having conversations with our healthcare providers about what feels right for us when it comes to spirituality and religion. So Dr. Pool, as someone who is a practicing physician, tell me a little bit more about any experiences you might have had with these topics in the doctor's office.

Speaker 3: You know it, it's not something that happens very often or as often as people would think. And I think that there are barriers on both sides. So when you think about the barrier on the side of the healthcare [00:01:30] provider, right, and, and I mean physicians, nurses, et cetera, there's always this concept of time. The providers are there to hear what the patients are presenting and trying to figure out what the issue is and how to solve that issue. And there's not a lot of time. The other issue though, is I don't think people are, I wouldn't say that they're not comfortable, but I would say that there's this hesitancy to not offend. And so I think a lot [00:02:00] of healthcare providers aren't sure that patients themselves want to talk about things and they don't know where people are as it relates to their spirituality or into religion and if they want that brought into things or not. And so when you combine that with their already being a finite amount of time, it doesn't get brought up. On the flip side, I think patients have some hesitancy as well because they don't know how a physician may react. [00:02:30] I think a lot of times spirituality, religion matters of faith are probably at the forefront of a patient's mind when he or she is interacting with the healthcare system. But they don't know if the person on the other end is ready to have that conversation and I think they don't bring it up.

Speaker 2: Yeah, I'm thinking from my own perspective as a birth doula and a debt doula, I walk this like very interesting line because I'm there to sort of wrap my arms around patients and help guide through the health [00:03:00] system. So the opportunity to speak about spirituality and religion is inherently within that role. And because the events of being born and dying are very spiritual for a lot of people, it's a natural entry point into having that conversation and having that be a part of the experience that people have when we work together. Versus, I hear what you're saying where, you know, when I think about myself going to the doctor's office, I do think I would have some hesitancy to say, Hey, these are some of the things that I believe in, [00:03:30] mostly because I would be afraid to be judged and to think about how that would then impact my care. So I can see what you're describing of like, where's the open space for those things to come together. Today we're gonna learn even more about that and kind of expand this conversation. So to get us grounded with some facts, we talked with Dr. Mary Jo Kreitzer, she's a professor and the director of the University of Minnesota Center for Spirituality and Healing. She has spent her career studying this very topic. Let's listen in.

Speaker 2: [00:04:00] Thank you so much for joining us, Dr. Mary Jo Kreitzer, we're really excited to have you here. Before we get started, can you share with us a little bit about who you are and what your background is?

Speaker 4: Sure. I am the founder and director of the Early Bachan Center for Spirituality and Healing at the University of Minnesota, where I'm also a professor in the school of nursing. So my background is in both nursing, public health, and in the whole field of integrative [00:04:30] health and healing.

Speaker 2: And tell me a little bit more about how you got into this space. How did you see all of these things coming together?

Speaker 4: Well, that's really an interesting question. I was in an administrative post at the University of Minnesota Hospital and Clinic, and I was the director of nursing practice and research. I became the administrator of quality for the health system and the administrator for spiritual care. And I think Kelly, at that time, I saw that there was such an opportunity [00:05:00] to really step back and look at how do we care for the whole person, body, mind, and spirit. And even at that time, you know, 30 plus years ago, we were caring for people who spoke 20 different languages. And for many people, many patients in their families, their spiritual, religious, and cultural beliefs and practices where every bit as important as anything we might be bringing them from a western medicine perspective. [00:05:30] So I really became interested, how is a healthcare system can we become more attentive to the whole person?

Speaker 4: And I think it begins with even defining terms and defining what spirituality is. And I define spirituality very broadly as that which gives meaning and purpose to life. Hmm. And so if you look at kind of care of people from the perspective of spirituality, you know, focusing on what gives people meaning and purpose to life is just [00:06:00] critically important. You know, religion is also important, but beyond spirituality and religion, there's also culture. And when you think about culture, there are cultural beliefs, practices, and rituals that are also really important to people. And so I think as health systems, thinking about how we can be attentive to all of those aspects of who a person is, you know, is really important.

Speaker 2: This is a fascinating [00:06:30] conversation and I'm wondering how we got from historical context like you're describing, where these things are deeply integrated and seen as one and the same to where we are today with a medical profession that views these as being very separate.

Speaker 4: Well, you know, I think it happened because I think for so many healthcare providers, they just didn't see that as part of professional practice. And physicians and nurses historically received very little formal education. And the models on spirituality and how [00:07:00] to even approach a topic of spirituality and models of care were focused very much on the physical body. And so I think that is actually what happened. You know, over time and very interesting studies have emerged that if you ask consumers do you want your healthcare provider to talk about spiritual matters, they will say yes, A very high percent, you know, a, a recent C n N article said 83% of patients want physicians [00:07:30] to talk with them about spiritual matters and have a conversation. Polls of healthcare providers will show that a relatively small percent feel prepared or comfortable addressing spirituality. So I think that's why it's been quite a challenge to figure out, you know, how do we provide sufficient education to healthcare providers so they feel prepared to do that.

Speaker 2: You know, I'm a birth doula and a death doula, so a lot of the way I think about my work is helping people transition between spiritual [00:08:00] and physical, physical and spiritual realms. And that works because I'm this third party in some ways that's offering support to wrap around a medical professional and the person that we're working with. And my question for you is, as we think about 83% of people that wanna feel like that's actually just a natural part of their conversation with their provider, what could that look like in a way that makes sense with the provider training that's available today?

Speaker 4: Well, I think Kelly, one of the things that's important is, you know, to [00:08:30] educate healthcare professionals about the lack of separation between body, mind, and spirit. They're intricately linked together. And then to begin to help people understand how do you even have a conversation? So one of the things that I often talk about is that in healthcare we sometimes focus way too much on what's the matter rather than what matters. And just think about the difference, those two questions. So if somebody is faced with a very complex [00:09:00] chronic disease or a new diagnosis, that's a devastating diagnosis. Asking the question what matters is really, really important. Because what matters may influence care treatment options. People wanna pursue who they wanna have involved in the care, what their goals are gonna be in terms of treatment of healthcare. And asking the question, what matters really begins to get to the heart of spirituality, [00:09:30] purpose in meaning.

Speaker 4: And so that is an example of kind of one thing that we can begin, you know, teaching healthcare professionals. But I think it's just like we teach people to do a health history. There are other questions that can be asked that really give people a sense that goes down a path of spirituality, religion, culturally, beliefs and practices. Asking questions like what gives you hope and meaning, what spiritual [00:10:00] practices are life giving for you? You know, are there specific practices or restrictions that we should know about? Um, do you have spiritual concerns or issues that you would like to address? And then also asking, are you part of a religious or spiritual community? And those are all questions that are gonna open up a conversation that you know, focuses on spirituality.

Speaker 3: As I hear you talk, it makes me think that [00:10:30] truly integrating spirituality into the exam room or at the bedside, particularly for nurses and physicians, represents a shift really in terms of how these folks traditionally practice and how they're trained. Right. And you know, we talk about training physicians more about business or more about, you know, certain things that they don't traditionally get. And so my question to you is, first off, are [00:11:00] there tools or methods that are available to better train healthcare professionals to integrate spirituality into delivering care? And if so, are there best practices or recommendations of how to integrate those things into their education and their training?

Speaker 4: Yeah, well it's a great question and I would say that, you know, what is considered best practice has changed. Right now we have an incredible [00:11:30] epidemic of stress and burnout in the healthcare professions. And that was true even before the pandemic. So what is emerging as best practice is we need in medical education, undergraduate medical students, residents, nurses, to begin to focus on self-care. And as we begin focusing on care of self, that is an incredible opportunity to look at oneself as a whole person, you know, body, mind, [00:12:00] and spirit. And so I think now it is becoming best practice to introduce concepts of wellbeing, resilience in health, professional education. The National Academy of Medicine has actually had a wellbeing initiative for quite a few years now, looking at how do we attend a wellbeing not only within healthcare providers, but also bring wellbeing into the healthcare system.

Speaker 4: And at the Baen Center for [00:12:30] Spirituality and Healing, when we talk about wellbeing and a wellbeing perspective, that's more than just health. So health contributes to wellbeing, but purpose is also a big aspect of wellbeing. Purpose contributes a lot towards wellbeing. Think about people that, you know, you might know somebody who has great health, but they don't have wellbeing. And you might also know people that have really compromised health, but they exude wellbeing in their life. And [00:13:00] that's often because they have strong purpose in life. And so when I talk about purpose, that really is about meaning and connection. And so from a wellbeing perspective, health is important. Looking at all aspects of health, physical health, social health, mental health purpose is important. Another aspect of wellbeing that's really critical, our relationships, and you know, in the United States [00:13:30] there's a lot of depression. There's even more loneliness than depression. And the health risks of being alone are comparable to all kinds of chronic diseases. And so health purpose, relationships, community contributes to our wellbeing, a feeling of security and the environment in which we are. And when you think about it, you know, if you look at people from a wellbeing perspective, you know, spirituality, religion, [00:14:00] cultural beliefs and practices, they transcend all of those aspects of wellbeing.

Speaker 3: How would somebody then go about accessing spiritual care? As I'm asking the question and even thinking about my experiences as a physician, a lot of times spiritual services are there for extreme care, if you will, hospice, palliative care people in the end stages of life, or a lot of times, again, you know, on [00:14:30] the beginning side, right, people are having babies and things like that. But when people are there for routine care, usually you don't see spiritual care integrated in. And then certainly in the outpatient setting, it's not something that's readily available. So how do patients undergoing routine care access spiritual care?

Speaker 4: Well, I, I think asking their healthcare provider, uh, you know, would be a place that, that a healthcare provider could make a referral. But [00:15:00] many patients are already part of a spiritual or religious community. And it might be within that community-based setting that they also might turn, if they're like a healthy outpatient to get spiritual support. And there's another profession that's emerged, um, spiritual direction. And so there are ways to find spiritual directors and there're often at retreat centers, you know, spirituality centers, that's another [00:15:30] path if people wanna delve deeply into their own spirituality that they could pursue

Speaker 3: You. You mentioned that a lot of times, you know, in the context of routine episodes of care and even in other cases people also lean on their quote unquote outside spiritual care, meaning the spiritual community that they adhere to outside of the healthcare system. And so how do those things mesh? Right? If I'm a patient and I want to integrate spiritual care into the [00:16:00] healthcare that I'm receiving, how do the spiritual care services that are available on the healthcare side mesh with the pastor or preacher or priest or rabbi or faith leader that I have on my own?

Speaker 4: Well, hopefully they might compliment what you're getting on your own. You know, while you might not have access to your, you know, faith leader or your preacher. And so, you know, again, on the inpatient [00:16:30] side, I think what's most important is asking questions that give patients an opening, an opening to even make that connection. So asking questions, what gives you hope and meaning and what gives hope and meaning might be connecting to their spiritual community. And then asking what spiritual practices are life giving to you? Well that might be prayer, that might be meditation, that might be journaling. Asking people if they're part of a religious or spiritual community. And if the answer to that is [00:17:00] yes, you know, while you're a patient, is there somebody that could come in from part of that community? Do you want us to involve somebody from your spiritual, a religious community as part of your care? So I think asking those questions creates an opportunity to establish a bridge. If people have support on the outside that they wanna integrate on the inside.

Speaker 2: If you're a patient and wanting to speak with your doctor about this, what are some of the ways that you might naturally do that?

Speaker 4: [00:17:30] You know, Callie, I'm passionate about giving consumers better tools to get what they need and want [laugh]. And so, you know, at the Bogan Center we actually have a whole website titled Taking Charge of Your Health and Wellbeing. And we get about a quarter of a million unique visitors a month from that website from all around the world. And what we often encourage people to do is write down what's important to you. And if you have questions that you wanna ask, write down [00:18:00] the questions that you wanna ask. Cuz what often happens is that you know, patients will get into the exam room and naturally they often feel anxious. And what happens when they feel anxious, they forget everything [laugh] that they were gonna talk about. So writing it down I think is really a good idea. Sometimes bringing somebody with you. And so if it's important to talk about spirituality, you know, write down what you wanna discuss with your healthcare provider, that's what I think is a good [00:18:30] strategy.

Speaker 2: That's great. So to kind of close this part of the interview, thank you so much for being here. We're gonna move into the lightning round, which is where I'll ask you a series of questions and you can respond personally or professionally with whatever is top of mind. Does that sound good? Sure. Okay. So our first question is, what's an impactful professional lesson that you've had to learn?

Speaker 4: Well, you know, I think there's two things that come to mind. I think the first one is you can accomplish a lot more if you can let go of getting credit. And [00:19:00] the second would be that being right is not always what matters most.

Speaker 3: I got one for you. You have a magic wand and you can do one major thing to fix the healthcare system. What would it be?

Speaker 4: Oh, center, the whole healthcare system around Whole Person health. Hmm.

Speaker 2: What's something that has surprised you in a good way recently?

Speaker 4: Uh, transformation of the workplace. I think the changes that were accelerated by the pandemic [00:19:30] and that we'll endure our breathtaking and very refreshing.

Speaker 3: And then I sense some optimism in your answers. And so I'm curious what gives you hope?

Speaker 4: Uh, you know, these are very challenging times I think from the societal perspective, from the political perspective, from the healthcare system. But some things, sometimes things need to implode before new possibilities emerge. Sure. And stable systems [00:20:00] are often resistant to change and unstable systems are open to change. And so that actually is what gives me hope right now. There's so much chaos and turbulence in the healthcare system that there are openings for new ideas and new possibilities. And so I actually think it's a great time for innovation.

Speaker 2: Wow. There you go.

Speaker 3: Well, Dr. Mary Jo Kreiter, thank you so much. This was a joy. Yeah. I really appreciate it.

Speaker 4: Well you're very welcome. Glad to join you today.

Speaker 3: [00:20:30] Coming off the interview with Dr. Mary Jo Kreiter, she talked about patients being equipped and going into an office, knowing what matters to them, and even having that prepared and written down. And I think that's so important. Cause a lot of times people lose sight of exactly how they want to be treated and what they're looking for, particularly once they get into a doctor's office and emotions and [00:21:00] other things start taking over. And so having what they want to accomplish and what they wanna get out of the visit written down much in the same way that people write down a list of ailments or medications or past medical history, I think is a huge concept. And I think is something that will help not only the patient, but also the care team that takes care of that patient. And I thought it was huge that she talked about shifting the focus from what's the matter with you to actually what matters to you. [00:21:30] Yes. I think that's something we can and should explore a little bit later at some point.

Speaker 2: I love that. And I think what is also important about that is just feeling more empowered within our own health journey because we're asking these questions and we're clear about what is important to us in terms of priority. And so one of the things I think about in working with some of my clients who are dying is how they want their end of life to look. And for some of them it might be, Hey, this really important event is happening. My son is getting married in two weeks, so we're not gonna extend the [00:22:00] duration of life, but like, I want my quality of life to be really good until I can hit this two weeks and then maybe I'm in a different place after that. And so setting those goals and priorities and communicating that so it feels like, hey, we're all on the same team here and we can really create care plans around what's important is great. So that's one example that's specific to death. But I think to your point, there's so many ways of, you know, bringing that information into the doctor's office and having a more expansive conversation.

Speaker 3: You know, when I was at Mayo, one of my main administrative roles [00:22:30] was that I oversaw patient experience. And so whenever I saw patients, and even when I see patients now, I keep that lens with me. And one of the things that that's taught me is to make sure that every person that comes into an exam room accomplishes what they set out to accomplish when they show up. Because a lot of times people come in and they get caught up in what all is going on in the line [00:23:00] of questioning and trying to fit everything into a certain period of time, and sometimes just being intimidated and or embarrassed and don't really put forward what it is they're actually there for. And so I always think that one of the main goals when I see a patient is to figure out what exactly they're there for. Like why did they make this appointment and make sure that we address that. And even when I would supervise residents, I would tell 'em one of your main, if not your main goal [00:23:30] for this visit is to find out exactly why this person is here and to make sure that we address his or her concern.

Speaker 2: Yeah, I love that. And again, I think that goes back to the comment around feeling empowered within your health and creating that entry point that we described earlier of being able to have that conversation in a natural way with our provider. We also wanted to hear from someone who's out making the rounds, if you will, working with patients to support their spiritual needs within healthcare settings. Brian Hughes is a chaplain and spiritual care specialist with United Health [00:24:00] Group and was generous enough to sit with us to share his experiences and insights.

Speaker 3: Brian, I just want to jump right into it and have you talk a little bit about your journey to chaplaincy in terms of what that looks like and then how you arrived at United Health Group.

Speaker 1: Sure. No, I appreciate it and thanks for having me today. So I'm a board certified chaplain through the Association of Professional Chaplains and also an advanced practice board certified chaplain [00:24:30] through the Spiritual Care Association. I have worked in acute care hospitals in New York City, in Philadelphia, in Dallas, and in Phoenix. Started part-time as a contractor with Texas Community and State within United where we would provide support for members who had been screened for spiritual distress. And I've kind of expanded and evolved the role a little bit to also work in the Family Engagement Center, which is a part of the United Healthcare. And [00:25:00] there we provide support for both members as well as for staff. And then right as Covid hit began to help another team of advanced practice clinicians, uh, nurse practitioners, mostly working in long-term care because they were uniquely hit at the right, at the outside of Covid, February, March, 2020. And so really came over there to help provide support for the nurse practitioners that were losing sometimes 20, 30, even 40% of their census in a very short amount of time with Covid and have been with the organization [00:25:30] about coming up on five years. Um, moving, transitioning out shortly from my time in the Family engagement center and into a new role that'll be focused on staff support with clinicians.

Speaker 3: I'm curious, Brian, how how'd you get interested in this work? Like where did your motivation for this come from and kind of how'd you end up here as opposed to being an accountant or whatever, you know?

Speaker 1: Sure. No, good question. So I'm a, I'm a son and grandson and great grandson of, uh, ministers of a Christian [00:26:00] faith. Growing up as a preacher's kid, uh, in a small church, you know, I'd go with my dad to hospitals and I hated it. [laugh]. Um, you know, hospitals were intimidating as where sick people were and dead people were, and dying people were. And that just, that had no appeal to me in any way growing up. But once I went into graduate school, I did seminary at Princeton Seminary in New Jersey, um, and we had to do field eds. I knew I didn't wanna work in a church when I went into a hospital and there is a C E O in room four and [00:26:30] a homeless person in room five, and they both get the paper gown that opens in the back and they're both asking the same questions about the same diagnoses, which is, wait a second, I'm a good person.

Speaker 1: Why is this happening to me? Where is God in this? Why doesn't, you know, whatever, I mean, whatever their questions were just, were much grittier, kind of more raw mm-hmm. [affirmative] more authentic is maybe the word that I'm really kind of, yeah. That authenticity was everything to me. Uh, and just inviting that conversation of exploring how are we making sense [00:27:00] of what's happening now of something that in realistic terms, d we can't make sense of you. Were struck by lightning. This is your third cancer diagnosis of a different primary cancer, uh, in the last 10 years. That's like, there's no answer to that medically. There's no answer to that kind of even existentially. It's just, here we are and so how are we gonna get through this? Those kind of questions are really compelling to me. And walking with people I have seen and experienced times when the conversation is much more healing, [00:27:30] not because of anything I did, but just having invited the conversation.

Speaker 2: Yep. Wow. Yep. Can you tell us a little bit about what a chaplain is and what they do? And then you mentioned screening for spiritual distress, and I am so curious to hear a little bit more about what that is and what that looks like.

Speaker 1: You know, a board certified chaplain is gonna be a professional that often is ordained within their own religious tradition. You don't have to be religious. Uh, one of my best friends and a chaplain I would [00:28:00] want at my bedside if I were a patient is a secular humanist. He's atheistic and outta New York City and runs one of the chaplaincy programs there because the fundamental ethic really of chaplaincy is not that as a religious person, I am trying to provide my answers to someone else's distress. Rather, it is to engage people in a space of absolute and kind of sacrosanct, uh, respect for their own meaning making and set of values. And for [00:28:30] many people that way may well be religious. For others it may be just about meaning making and connection. And so ultimately my role is to connect a person with their own religious or spiritual frame or existential frame to help them navigate the healthcare journey they're on.

Speaker 1: Because for a lot of people, maybe with the exception of, of live healthy baby birth, um, even that is a disruption of, uh, existential, uh, distress for many. But most healthcare journeys are [00:29:00] an unwelcome interruption into a person's otherwise kind of routine life. And so when there's that interruption, there's a question of, okay, what now how do I make meaning in this space? Things were going great and now they're not. I have this new diagnosis, who am I now? How do I relate to my family, to myself, to the universe, to God? Those kind of things. And so as a chaplain, my role is to try to help a person explore their own values, their own upbringing, their own background, and connect [00:29:30] them to those as resources as much as possible, as opposed to saying, well, here's what I would do if I were in your shoes.

Speaker 2: Yeah. And talk to us a little bit about spiritual distress and the screenings you were doing. That is a really interesting terminology that I did not know there was a screening process for.

Speaker 1: Yeah. There, you know, in general there are really three levels of screening and assessment for spiritual distress. There's the screen, which is some version of inquiring as to whether somebody might [00:30:00] be experiencing either religious or spiritual distress. And that is the idea that my values and my assumptions about life in general and my life in particular are disrupted right now for some reason. And so how do I make sense of what's happening right now? That's kind of a functional definition of spiritual distress, um, or existential distress. Religious distress might be my religion says I can't or shouldn't be doing these things, or I can and should be doing those. And yet I'm a little confused with what to [00:30:30] do now because the doctors are saying to do this or not do that. And so there might be sometimes some point of tension or distress there.

Speaker 1: It's the same way as you're going through and finding out someone's home address and history of their medical condition and those kind of things where you can ask questions such as, are you at peace? Is is a really good, uh, spiritual screen. Uh, it's one of the most validated, reliable spiritual screens out there. Also, you know, would [00:31:00] you have what you are considering to be spiritual or religious distress? Um, it's kind of like asking about burnout or something or pain. Uh, it's just asking the question, uh, kind of on a scale from one to 10 of distress thermometer kind of situation. But then there's also a spiritual history and that's normally done a little more in depth and that can be incorporated and really should be incorporated by the clinicians as a part of the history and physical of, of an assessment of a patient.

Speaker 1: There are different instruments for that, but the gist is do you have a faith tradition that you're a part of? How [00:31:30] important is that to you? Is there a community that's associated with that? How can we address or engage those values that you have in our plan of care? So that's really kind of at a clinician level. And then there's the in-depth spiritual assessment that's really kind of at the spiritual care specialist level, that's the board certified chaplain often coming in and doing a more in-depth kind of exploration as well as potential spiritual care interventions.

Speaker 2: I'm wondering if you have any experience caring for someone in this holistic [00:32:00] type of way or if there's a story you could tell that kind of exemplifies these ideas.

Speaker 1: How, how much time do we have? Uh, I have, I have lots of stories in that, in that space. Um, you know, recently from my work here at United, I'm wrapping up my time in the family engagement center after having been there about three and a half years, where part of my role is reaching out to members, uh, and providing support when they're in distress. And interestingly, the first member I called three and a half years ago, I spent about a year and a half off and on with some interventions and, and telephonic [00:32:30] chaplaincy support hadn't heard from her in about a year and a half. And then heard from her last week as I'm wrapping up my time in the family engagement center, unbeknownst to her, she reached out and asked me to to call her. So I called her again yesterday. It provided and spurred conversations for her that now three years later, she told me yesterday, uh, when we spoke how much better things are for her and for her children. Wow. Largely because we were able to kind of unpack some of her own concern and reticence about that, but also address and [00:33:00] resolve some of what she felt like were very unresolved. And so that's just one example of many.

Speaker 3: Ryan, let me ask you, what's being done to encourage this type of integration of spirituality, faith into healthcare?

Speaker 1: More and more clinical training. So both the US graduate medical education for physician training as well as nurses and nurse practitioners are incorporating some aspect of spirituality [00:33:30] in the training, which generationally will have a, a significant impact. And having that be a central, if you wanna be board certified in hospice and palliative medicine, you have to be able to demonstrate a proficiency and an awareness of how to integrate spirituality and religion and existential concerns into healthcare into your practice. Sure. So that's really, um, kind of trickling down, uh, beyond just palliative care. That's one aspect of it. The uptick in research is significant as an evidence-based best practice, um, tradition. And within medicine, the more evidence around [00:34:00] how impactful either the inclusion or exclusion of, uh, spirituality and faith in the context of healthcare is, the more that becomes prioritized.

Speaker 3: You know, with all of that being said, how does a patient then contact or request, if you will, spiritual care outside of those extreme cases, right? Mm-hmm. [affirmative], like outside of there being a dire circumstance in the hospital. [00:34:30] So somebody who is seeking telehealth or somebody who is looking for, uh, spiritual guidance during routine care, if you will.

Speaker 1: Yeah, I, the best thing I would encourage, I mean I would say this for things beyond spiritual care as well, but is to write down the question before you go in the room. Because sometimes in the room with a clinician, our mind goes blank and we're just kind of in this discombobulated space emotionally and spiritually. Um, but write down the question and ask your [00:35:00] clinician that you're engaging, say, you know, I have some questions or some concerns that are related to my spirituality and my faith. Is there someone that in your system that I can talk with? Different places have different ways of doing that. My hope is, um, and kind of in an ideal, you're gonna end up with a board certified chaplain that's gonna come from that place of ultimate respect for your own faith tradition or your own spirituality. You know, in its idiosyncrasies. Some places may use social workers, some places may use volunteers or local clergy if it's a smaller community, that kind of thing. But even [00:35:30] then the attempt or the goal should be to try to help connect and explore the patient's own values and how they interact with the care system.

Speaker 2: I also wanna ask you about the bonfires because I know that that's been a large part of your role with U H G. Can you share a little bit more about what that is?

Speaker 1: Sure. So right as Covid began, and I was working with nurse practitioners in long-term care centers. So some of these nurse practitioners were losing 30, 40, I think a had a couple lose literally 50% of their census. Um, as wow, covid just burned [00:36:00] through the homes almost like a wildfire. It would start at the nurses' station and the next day, you know, there'd be a positive two rooms from the nurses' station the next day before rooms and it just down the hall and often, you know, pre vaccine and stuff. And so had a, had a really high mortality, understandably that had a significant impact on the care providers. Um, and so there was a, a team in Arizona that had been acutely hit and in kind of brainstorming with the director there, we were trying to come up with some way to offer a safe space for them to share [00:36:30] their own grief, kind of cumulative grief as well as just scream into the universe [laugh], for lack of a better term, into the, yeah.

Speaker 1: And so what we ended up doing was kind of creating, it's a virtual experience. It's like using Zoom or Teams, we use teams, but where we invited people in and, and they're all on mute, but I have virtual prompts such as my most recent kind of iteration of the bonfire is asking people, how has Covid impacted your work and what's been hard? [00:37:00] How has Covid impacted your life outside of work? What's been hard? And so when people respond though, the concern was if they're in a group of colleagues or a group maybe of colleagues that they don't know, cuz we're a huge organization, how could they respond to comments in a way that was safe? And so rather than having them respond in kind of a group chat for the meeting, they respond by chatting privately to me in kind of a private message in the same time simultaneously with kind of the idea of as it's like as if people are writing things [00:37:30] down on a piece of paper, folding it up and passing it to me, right?

Speaker 1: If we were in person, that's the idea. And then at the end of that time, I would read those aloud as they're coming in, but they'd be anonymous to the group. So people hear their own comments and they hear other people's comments, but no one knows who made which comment. Um, and then we have a virtual bonfire together. The idea again, if we were together in person, that we would throw these pieces of paper in the bonfire and encourage people to try to let go to release some of that burden, um, maybe to unc Unclench a little of that kind [00:38:00] of intensity of what they've been experiencing. Yeah. And then move forward into kind of a place of, uh, hope and what have you learned and how are things better and what are you pulling forward from Covid that's positive for you as a, as a clinician or as a professional or as a person.

Speaker 1: We've done over a hundred of 'em now organization-wide with over 7,000 participants and, um, another 2,500 or so have done the on-demand version of that kind of re prerecorded. We have it recorded in Spanish as well. [00:38:30] It moved from originally with that group in Arizona to become kind of within the center for Clinician advancement and specifically the joy and practice team. And so that's working mostly inviting clinicians organization-wide, of which there are tens of thousands. So we tend to have about 50 to 75 per, um, I do about one live one per week, uh, for the last couple years. And so it's been, it's been super meaningful to me even though I'm literally reading the same script and going through the same slides. Everyone's comments are always different. [00:39:00] And the two most common sentiments and feedback are, oh my gosh, I had no idea how much I needed that. Um, just kind of that release at work and recognition that I've been carrying around all of these burdens that are work related. And the second piece of that is, oh my gosh, I had no idea. I wasn't the only person I I I thought I was the only person feeling this way. But hearing everyone else's comments is like, oh you too, you too, you too. Yeah. So it's been really healing.

Speaker 2: Wow. Yeah. You are an amazing person. This is such an incredible conversation. [00:39:30] Like I said, I could probably talk to you forever. I'm sure Kenny feels the same way. So I'm gonna move us into the lightning round, which is where we will ask you a series of questions and we'd love to hear from a professional or personal perspective, what is top of mind for you? So our first question is, what's an impactful professional lesson that you've needed to learn?

Speaker 1: [laugh] coming to United was how to translate chaplaincy care that kind of makes sense in healthcare setting [00:40:00] and even then is often overed and underutilized. How to start from ground zero in a much more business structure. How to learn the system, the culture, the language in such a way to say, you know, these things that are keeping you up at night. Uh, boss person, [laugh], we could a chaplain and the scope of practice for a chaplain can have a unique benefit to those things. So things like for example around staff support, so retention, burnout, employee engagement, those are good examples of, [00:40:30] you know, where a chaplain can be involved, can have a unique impact in those places. So having to learn how to interpret and bridge that conversation has really been, um, challenging and exciting.

Speaker 3: My question is, what's a bright spot about the healthcare system right now?

Speaker 1: I think a lot of clinicians recognize that healthcare should be much more holistic, much more whole person care. So just that humanization maybe of medicine, uh, has been really encouraging and I think that bears out in both research and, and kind [00:41:00] of bringing or not being quite as phobic of spiritual, um, and religious and existential, um, measures.

Speaker 2: Amazing. Thank you so much for joining us.

Speaker 1: That was great.

Speaker 2: I really appreciated how Brian positioned the role of a care chaplain as being one that helps people make their own meaning and connect with their own values rather than, you know, trying to provide answers to somebody who is in distress.

Speaker 3: [00:41:30] And I think he did a really good job setting up how chaplain services can be appropriately utilized and what exactly they are. Because a lot of times people don't fully realize what the chaplains are equipped to do and what they're there to do. And that includes both patients and then also those providing care.

Speaker 2: Yeah, absolutely. And I love that he's there as this support similar to a role that a doula might play with the intent of like providing emotional support and being able to create meaning for people because we are meaning [00:42:00] making machines. And so when these things happen, you know, big medical events, it can be really confusing and confronting and having support there through someone like a chaplain is really helpful, I think.

Speaker 3: Yeah, and he talked about writing down questions before going into appointments as well. And if you go back to that conversation we had with Dr. Mary Jo Kreiter and her recommendations of writing down not only what you want to accomplish but what really matters to you, I think it all came together really [00:42:30] well and made sense.

Speaker 2: That is a great tee up for our bonus episode next week where we will be sharing some tactics for how you can set yourself up for success when it comes to getting your spirituality needs met.

Speaker 3: So that's it for today. Thanks for listening. Make sure to follow or subscribe wherever you listen so you can be notified when a new episode is live. Catch you next time.