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BY: PAMELA A. MAIDENS, M.A., C.L.E.M.

This then, is the vineyard; this is the field in which the faithful are called to fulfill their mission.
— Pope John Paul II¹

Catholic health care is a vineyard where many people work to carry out the mission of faith-based care. The New Testament gives us the model for fulfilling this mission: A person seeks relief from suffering and encounters a Christ-centered response, God's presence is made manifest, healing occurs and the suffering person is made whole in body, mind and spirit. Both caregiver and care recipient are strengthened and renewed in relationship with God and with each other. By example and through his parables, Jesus teaches that such strengthening, renewal and spiritual enrichment are important parts of the healing mission.

When we are talking about our patients, we call this "whole person care." What we sometimes forget is that the mission includes the caregiver. A health care staff member who understands himself or herself as a whole person is more likely to understand and care for others this way. Thus if we are to expect whole person care from our caregivers, we must, in fairness, provide renewing opportunities that nourish the interior life of the caregiver in body, mind and spirit.

Mother Teresa, founder of the Missionaries of Charity, taught, "We must have a community or environment that nurtures our spiritual growth and our vocation to serve others."² Caregivers often report they neglect their own health and well-being, and even if they manage to eat well and get some exercise, many say they find little time to nourish their spirituality or relationships.³

The question is, how do our organizations nurture their caregivers' vocation and spiritual growth? One way is staff development that helps a caregiver see himself or herself as a person in relationship with God and others, understand whole-person-centered care more deeply and know how to apply it personally.

With that goal in mind, Catholic Community Connection, a Cleveland-based organization of 20 Catholic-sponsored education, health care, human services and senior living ministries in northeast Ohio, began work on a quality improvement initiative to foster whole-person-centered care and to nurture the interior life of the caregiver.

PLANNING, MARCH 2004
The first steps of this initiative were to identify organizational needs and develop a valid response. The Cleveland Foundation provided a planning grant, and Catholic Community Connection engaged health care experts as members of a design team to provide direction for the collaborative group. Robyn Stone, Dr.P.H., executive director of the LeadingAge Center for Applied Research in Washington, D.C., and senior vice president of research, directed the research component of the initiative which included focus groups with patients, residents, staffs and volunteers throughout the Catholic organizations.

That's where the project took an unexpected turn. The research showed staff members did not understand the components of whole-person-centered care and how they applied to themselves, much less how to apply them to patients. Consequently, what began as a patient-focused initiative shifted to a workforce initiative to respond to the needs of health care staff.

To that end, the design team created the Abundant Life Wellness Awareness Tool and the education program called Abundant Life, Care for the body, mind, and spirit™ based on John 10:10 in which Jesus says, "I came so that they might have life and have it more abundantly." It supports the philosophy that every person is an inseparable unity of body, mind and spirit and that care for the whole person contributes to well-being and fuller, more meaningful life. It is similar to a course psycho-gerontologist Thomas Kitwood designed in 1996 in which he provided medical students with "an opportunity to explore and develop the feeling, emotional and intuitive parts of themselves."⁴

The wellness awareness tool gives individuals of all cultural backgrounds, economic conditions and faith traditions an opportunity to consider components of their own care and consequent well-being. The tool reflects considerable research recognized by the World Health Organization as backing the theory that the response to a health problem is more likely to be effective if the provider understands its various dimensions.⁵

"Our research in the area of quality of care and quality of life in aging services has demonstrated the need for training that focuses on care for the body, mind and spirit," wrote Stone. "Your program is the first of its kind to address this issue in a comprehensive way across an alliance of diverse service organizations, staff and service recipients. It provides the framework for understanding why and how to bridge the care domains of body, mind and spirit."⁶

EDUCATION DEVELOPMENT AND IMPLEMENTATION, MARCH 2005
Grants from the Cleveland Foundation and the Sisters of Charity Foundation of Cleveland funded Phase II of the Abundant Life initiative. This phase included a process evaluation to create a successful program of adult education and a curriculum published in The Abundant Life Teacher's Manual for Wellness Education. The program includes short lectures, small group discussions, listening and communication exercises, case studies and wellness practices. The two-day process builds on caregivers' knowledge and skills to instill a sense of community, respect and trust among co-workers. The course interaction breaks down barriers, levels the field and reduces stress and depression commonly called burnout among professional caregivers.

The curriculum includes five major themes:

• Human dignity and wholeness
• Dimensions of wellness: physical, psychosocial and spiritual
• Good listening and communication skills
• Characteristics of healthy relationships
• Wellness practices such as deep breathing, prayer, meditation and tai chi

During Phase II, more than 100 multidisciplinary staffs participated in Abundant Life education, research focus groups and a process evaluation directed by Stone. Independent qualitative analysis indicated that people who completed the program felt it had not only improved their work life but also their home life. Staffs reported their health and well-being improved as they applied new stress management skills, better listening skills and wellness practices. They also described ways in which the Abundant Life program helped them improve their communication skills and develop a new appreciation of purpose in their lives and in their work.

Many participants reported that the Abundant Life spirituality component led them to greater job satisfaction and more participation in the social mission of their organizations. Eighty-nine percent of the participants reported they now understood whole person care as including physical, psychosocial and spiritual care, and they said they were better able to communicate how those three components are integral to well-being. Seventy-eight percent said the Abundant Life program changed the way they care for themselves and others. Participants reported specific changes relating to relationships and spirituality, such as greater awareness of the inherent connection between the body, mind and spirit; a new ability to distinguish between religion and spirituality and discuss them with others; and increased teamwork and patience with families, co-workers and patients.⁷

NURSING STAFF RESEARCH INITIATIVE, MARCH 2009
The 2009 Abundant Life initiative focused specifically on the development of nursing staff members and their ability to care for themselves and others as whole persons. A research study funded by the Chicago-based Retirement Research Foundation and the Sisters of Charity Foundation of Cleveland was conducted in partnership with Catholic Community Connection, the Department of Nursing at Notre Dame College of Ohio and LeadingAge Center for Applied Research, Washington, D.C.

Approximately 100 nursing staff participants drawn from seven facilities in northeast Ohio were divided into two groups, one that took the two-day Abundant Life program plus follow-up sessions and the other, a control group that did neither.

After completing the two-day education program, 97 percent of the Abundant Life group said that because of the program, they experienced a significant shift in the way they define wellness.

• 81 percent said they now recognized the value of whole person care with integration of body, mind and spirit
• 99 percent said the education presented a paradigm shift, personally and professionally

Other self-reported benefits included improved health and well-being, improved stress management, healthier relationships, new understanding of one's purpose and greater actualization of the social mission of their organization. This research validates an approach to care that requires few resources, yet has a sustained impact on enhancing wellness and improving quality of life, personally and professionally.⁸

DISSEMINATING WHOLE-PERSON-CENTERED CARE
Design team members, who contributed their own published material to the Abundant Life curriculum and co-facilitated the original education programs, continue to work with Catholic Community Connection and uphold the Abundant Life philosophy as they teach, serve and witness to health care professionals throughout the world. Additional experts also have joined the educators' roster and, like each participant, bring a fresh dimension to the program.

Employees from organizations throughout northeast Ohio have benefitted from Abundant Life. Mother Raphael Gregg, SJSM, administrator at Mount St. Joseph Nursing Home in Cleveland, was a member of the design team and attended the original Abundant Life education program with some of her staff. Through her commitment to the mission of Catholic health care, more than half of her employees have since participated in the education program. Today, Abundant Life continues to benefit caregivers and, consequently, residents, who call Mount St. Joseph their home.

In 2009 and again in 2010, Sr. M. Peter Lillian DiMaria, O.Carm., director of the Avila Institute of Gerontology in Germantown, N.Y., hosted Abundant Life for caregivers from multiple Avila organizations. On their written evaluations, participants said the Abundant Life education helped them to realize just how truly interconnected the body, mind and spirit are, "especially with regards to taking care of yourself as the caregiver so you can care for others, maintaining your own spirit and reminding others to embrace that aspect."⁹

EMBRACING THE CALL TO CARE FOR OURSELF
The calling of medicine is an art in which your heart will be exercised equally with your head.
— William Osler, MD¹⁰

The desire to serve, grounded in our spirituality, responds to a personal call. As this call leads us to help others to know God, it becomes a ministry. When we discern to make this ministry our lifework, it becomes our vocation. The ministry of care by any construct is a powerful experience that can fill us or drain us, depending upon how, and how well, we take care of ourselves.

Christine Puchalski, MD, began working with the Abundant Life initiative in 2003 as a design team member. She teaches that it is especially important for all of us, whether health care professionals, patients or administrators, to reclaim the spiritual roots of our medical profession. In her book, A Time for Listening and Caring: Spirituality and the Care of the Chronically Ill and Dying, she stresses the importance for professional caregivers to understand and appreciate their own spirituality as well as that of their patients.¹¹ Puchalski states that 72 percent of U.S. medical schools now teach courses on spirituality and health. This means that a new generation of clinicians is learning that spirituality is a universal component of every person.

Bruce Agneberg, MD, medical director of Agrace HospiceCare, Madison, Wis., and also a member of the Abundant Life design team, has been providing whole-person care for over 30 years. He suggests, "As professionals we have to have a good grasp of this [care for the body, mind, and spirit] for ourselves." He supports the integration of knowledge and skills that foster this whole-person care throughout life and recommends that educators "plug in" and integrate this whole-person care into medical curricula.¹²

A NOBLE VISION
Today, the health care arena is a complex world of rules and regulations designed to protect the caregiver and the care recipient. These mandates can lead to diagnoses based on three questions: "What's the problem?" "Where's the pain?" "What's the reimbursement code?"

Care for the whole person responds to the great commandment, "As I have loved you, so you also should love one another." (John 13:34) Faith-based health care organizations nurture those who manifest God's love in their ministry. Catholic Community Connection supports professional caregivers through Abundant Life education and welcomes opportunities to disseminate this outcomes-based program with individuals and organizations that share this noble vision.

The mission of Catholic health care is alive and, in spite of challenges, we continue to bless this ministry with works of "charity and zeal."¹³

PAMELA A. MAIDENS is director of mission education and spiritual development for Catholic Community Connection, Cleveland, Ohio, and co-director of Abundant Life, Care for the body, mind, and spirit.^TM

NOTES

1. Pope John Paul II, "On the Vocation and the Mission of the Lay Faithful in the Church and in the World." (Rome: Libreria Editrice Vaticana, 1998): 3.
2. Paul A. Wright, Mother Teresa's Prescription: Finding Happiness and Peace in Service. (Notre Dame, Ind.: Ave Maria Press, 2006), 68.
3. Catholic Community Connection, Abundant Life, Care for the body, mind, and spirit research focus groups, 2008.
4. Thomas Kitwood, a pioneer in the field of dementia care and founder of the Bradford Dementia Group, emphasized the value of the person, both caregiver and care recipient.
5. Moira Stewart, "Towards a Global Definition of Patient-Centered Care," BMJ 322 (2001): 444. Referenced in The World Health Report 2008 Primary Healthcare (Now More Than Ever), 46.
6. Catholic Community Connection, Abundant Life Teacher's Manual for Wellness Education, Foreword, v.
7. Institute for the Future of Aging Services (Now LeadingAge), Abundant Life, Care for the body, mind, and spirit Process Evaluation Report. (Washington, DC: IFAS, 2007). 15-16.
8. Catholic Community Connection, Abundant Life Nursing Outcomes Evaluation Report (Cleveland: 2011).
9. Abundant Life, care for the body, mind, and spirit participant evaluations: June 24, 2009 and August 25, 2010.
10. Harvey L. Cushing, The Life of Sir William Osler, Volume 1. (Hamburg: SEVERUS Verlag, 2010). Osler was the first physician-in-chief at Johns Hopkins Hospital and co-founder of the Johns Hopkins School of Medicine. Trained in his native Canada and in Europe, he is renowned for teaching small groups of medical students at hospital bedsides, emphasizing contact with the person receiving care.
11. Christina Puchalski, A Time for Listening and Caring: Spirituality and the Care of the Chronically Ill and Dying (New York: Oxford University Press, 2006): xii.
12. Catholic Community Connection, "Abundant Life Design Team Video," 2004, Cleveland.
13. "CHA's Beginnings," as published in Catholic Health World, July 15, 2004, www.chausa.org/Pages/About_CHA/How_CHA_Began/ Retrieved March 2011.

FEEDBACK from nursing staff participants

"It has made me realize how important my health is."

"... we had a much more stressful relationship prior to going through Abundant Life together. When you see them [your co-workers] as a person, with all of these different needs and desires, there's a trust that develops ... and our relationship has really changed as a result of that."

"I'm looking at residents totally different now. I'm spending more time looking at the body language of a person and really listening. And I want to know who they are. I mean, it's not just a job any more for me."

"The reality is that ... it's not what's happening out there that matters, it's how I respond to it."

"I just think it's been really a great self-awareness, you know. And hopefully it is doing the trickling effect ... that it's touching other people's lives like it's touched mine."

"Somewhere in one of the books, I read all about interactions with people, and you just don't know who you're interacting with or what that person might have gone through that day or week or year. That has really stuck with me, in my interactions with people."

"It's done so many positive things just for me personally, but also at work. I'm less negative. The Tool is thought provoking and I've given it to others to think about. It will always be with me and it won't fail. It's OK and not selfish to take care of myself."

"I've changed my eating and sleeping habits. I'm not eating as much fast food anymore. I'm getting enough sleep. And I find I have more and more energy, and I got rid of unwanted things."

"What I've learned, is I'm looking at residents totally differently now. I'm spending more time looking at the body language of a person and really listening, not just going in thinking that this person is on my assignment today, and I'm here to work with them, but this is a real person who might need me to listen to them. I feel better coming to work."

"When we're not using all the components or being sensitive to our body, mind, spirit, I see the interplay of how when I'm not taking care of my body, how it will affect my mind and spirit."

"I feel healthier, more relaxed, more focused on what's important not only in my personal life, but also my job."

DESIGN TEAM

Abundant Life design team members collaborating with Catholic Community Connection:

Bruce Agneberg, MD, senior vice president of medical services, Agrace HospiceCare, Madison, Wis.

Richard Groves, JCL, M.A., M.Div., author and co-founder and executive director of the Sacred Art of Living Center in Bend, Ore.

Roger Jahnke, OMD, author and CEO of Health Action, a health promotion and wellness training and research institute in Santa Barbara, Calif.

Christina Puchalski, MD, FACP, author and associate professor, Departments of Medicine and Healthcare Sciences, The George Washington University School of Medicine, Washington, D.C.

Robyn Stone, Dr.P.H., founder and director of LeadingAge Center for Applied Research, Washington, D.C. Stone is a noted researcher and internationally recognized authority on long-term care and aging policy.