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BY JULIE MINDA
April 29, 2020

The pandemic is wreaking havoc in the lives of patients, their loved ones, clinicians and other hospital staff. Spiritual care and social work staff members are under great stress too and they are feeling limited in their efforts to deliver supportive personal care, and offer guidance on complex medical decisions and grief counseling in an extremely challenging environment.

During an April 23 webinar, a panel of spiritual care and social work experts said the work of chaplains, social workers and those in similar nonclinical roles is more important than ever now. Through innovation, creativity and perseverance, they can find ways to effectively deliver essential care, without forfeiting their own emotional well-being, the panelists said.

Gonzales

"There's a lot we can't do now, but there also is a lot we can do," said Dennis Gonzales, CHA senior director of mission innovation and integration.

"Palliative Care Social Work and Chaplaincy during the COVID-19 Pandemic" was the fifth in a series of webinars from the Supportive Care Coalition and CHA. All of the webinars are available for replay at supportivecarecoalition.org. Click on the COVID-19 resources link at the top of the homepage.

During the social work and chaplaincy webinar, panelists discussed questions from participants related to goals of care conversations being held virtually, responding to the emotional and spiritual trauma of patients and family members, and the support of staff in moral distress.

Goals of care
Chaplain Sedona Montelongo of Dignity Health St. Joseph's Hospital and Medical Center, said that family meetings about goals of care, in general, can be challenging due to the sensitive nature of the conversation. Now, due to the pandemic, family meetings are not held in a quiet space with the usual sensitivity due to a "no visitor" policy. She said it is difficult to facilitate family discussions and decisions around goals of care for patients at the end of life when everyone is in the same room. Visitor prohibitions and social distancing practices in place at hospitals during the COVID-19 epidemic have made these conversations even more emotionally wrought for families. She said when next of kin cannot witness their loved one's physical deterioration and keep vigil at the bedside, many families will request aggressive and extraordinary treatments, since they may not grasp the futility of medical care and the likelihood it may cause suffering.

Montelongo

Montelongo said to give people a glimpse into their loved ones' reality and reassure them about the extent of spiritual and palliative care they are receiving, hospitals can send video recordings of spiritual care visits, nurse updates, and other care that happens in the patient room. She said this gives family members a better understanding of the loved one's health status before the goals of care conversations happen, and this is particularly useful when patients are incapable of speaking for themselves. She said several Dignity Health hospitals are using an app called Medical Memory, that a Dignity Health clinician created to document patient interactions in this way.

Levi

Panelist Jennifer Levi, senior social worker for Providence St. Joseph Health's Connections Palliative Care service, offered reassurance to social workers and spiritual care providers who worry about their ability to make compassionate connections over video screens or when their facial expressions are hidden behind masks. She said the fields are demonstrating the value of adaptability and creativity in the delivery of quality care.

Essential care
The panelists spoke of the importance of anticipating and responding to grieving families.

Montelongo said spiritual care staffs are being inundated with families experiencing complicated grief and traumatic stress. Many were not able to be physically present with their loved one before or at the time of death. Families cannot gather with friends and relations for traditional funerals or memorial services, because of rules strictly limiting in-person gatherings.

Even with the heavy workload for hospital-based spiritual care staffs in areas with COVID-19 outbreaks, Gonzales noted that there is talk at some health care facilities of reducing spiritual care staff to reduce costs. Many hospitals are struggling financially because they have cancelled elective and outpatient procedures to ensure they have the capacity to care for patients with serious complications from COVID-19.

Meyer McGrath

Gonzales said spiritual care staff are essential to the mission of Catholic health care and their presence must be preserved at ministry facilities. Citing statements by Catholic bishops, he said that hospital budgets are moral documents. "Show me what you spend your money on, and I'll see what you value," Gonzales said. Panelist Carrie Meyer McGrath, CHA director of mission services, said maintaining spiritual care staff presence will be increasingly important with the escalating need to emotionally support hospital clinicians and other staff.

Levi asked if it would be possible to task spiritual care providers whose workload has been reduced with the closure of outpatient offices with reaching out to outpatients who fall in high-risk groups, to encourage and support advance care planning discussions. Could these providers also be doing anticipatory grief work with loved ones of patients who are in rapid decline? Could they be running virtual support groups for people who have lost loved ones but who could not grieve in the traditional way?

Meyer McGrath said rituals can support a healthy grieving process. Even with virtual memorial services, it is important to include elements that were meaningful to the deceased and will make an emotional and spiritual connection with the bereaved. "Ritual tugs on built-in spiritual software in us," she said.

Suffering of caregivers
Panelists spoke of the heavy toll that the pandemic is taking on health care workers and the important role that spiritual care staff members will continue to have in addressing that distress, even well after the pandemic subsides.

Montelongo said it is essential for spiritual care staff to be a supportive, ongoing presence to co-workers, checking in on them. She said Dignity Health St. Joseph's Hospital and Medical Center has been setting up in-person listening stations and a spiritual care hotline for staff to talk about what they are feeling. While rounding, Montelongo offers essential oils to staff as a gesture of comfort and self-care, applying the extracts with cotton balls to the recipients' hands.

Gonzales said some Catholic health facilities have been providing a dedicated chaplain to staff members around the clock, some have been offering staff virtual support groups, many have been providing prayer and meditation resources.

Meyer McGrath said CHA also has been developing spiritual care resources for caregivers. This includes short meditations and centering prayers.

Levi mentioned the importance of using gentle language to try to foster a calmer environment. Speaking of "fighting" the virus and "battling" COVID-19 can amp up the level of distress, she said.

Self-care
The panelists spoke of how essential self-care is in countering spiritual distress.

Pastoral care staff must "refill their own wells," said Gonzales. Levi said pastoral care team members should lean on one another, providing an empathetic ear and emotional and spiritual support.

Montelongo said when she feels daunted by the many challenges presented in ministering to patients ill with COVID-19, she reminds herself that she likely is that patient's only in-person link to the people and world they love. As a spiritual care provider, she can deliver families' messages of love and support live, when they cannot be there.

"As spiritual care providers, we are the stand-ins, the proxies for families, and it brings all this into my heart-space when I remind myself of that," she said.

 View the webinar recording