research-J.Kim

AN ANANLYSIS
of
SPIRITUAL RISK
in
TRANSITIONAL CARE UNIT
(EXPERIMENTAL RESEARCH)
Presented
by
Jae Bum Kim
Chaplain Resident

3. RESEARCH METHOD
 Two months experiment
-From 2/1/15 to 3/31/15
-On Monday and Friday
 Confined to TCU (Total 20 beds)
 Referrals sources restricted to nurses, PCT’s and So-
cial Workers.
-Limited two (2) referrals per day : 21 out of 24 re-
sponded
 Chaplain prioritized cold visits
-Limited two (2) visits per day : 25 out of 26 re-
sponded
 Chaplain consulted with unit director, nurses, PCT’s
and Social Workers for this research.
 Using SDAT (Spiritual Distress Assessment Tools) to
score patient’s spiritual risks in number.
 Data Analysis:
-Use T-Test two independent samples
 P Value <0.05
4. SDAT (SPIRITUAL DISTRESS ASSESSMENT TOOL)
1. Meaning
The need for life balance and the need to be
able to cope with illness.
2. Transcendence
The need for connection with the patient’s
existential foundation.
3. Values Acknowledgement
The need for health professionals to know
and respect the patient’s values
4. Maintain Control
The need to understand the patient’s need to
feel included in decision-making process and
to be associates with health professionals’
decisions and actions.
5. Psycho-social identity
The need to be loved, to be heard, to be rec-
ognized, to have a positive image of oneself
and to feel forgiven.
1. INSPIRATION
 My Schedule
̶ Covering 3 clinical works and others:
Day Surgery, TCU, Palliative Care, On-call, CPE
̶ Early shift (6:15 a.m.- 3:30 p.m.)
̶ In times of high census
 Inquisitive mind (self-motivation)
 Enhancing research literacy
 Practicing experimental research
2. RESEARCH GOALS
 Evidence of need-based visitation
(Referral Based Visit vs. Cold Visit)
 Find a distinctive spiritual risk in TCU
 A Case study for need-based visitation
INTRODUCTION
Page 1/11J-term Research Project Jae Bum Kim
5. SCORING PROCESS

6. Structure of the Spiritual Needs Model
and the Spiritual Distress Assessment Tool
SPIRITUAL NEEDS MODEL SPIRITUAL DISTRESS TOOL (SDAT)
PATIENT INTERVIEW INTERVIEW ANALYSIS
Spiritual dimension Need associated with the
spiritual dimension
Set of questions for patient interview Questions for analysing the interview
and identifying unmet spiritual need
Scoring of unmet spiritual
need
(range from 0 to 3*)
MEANING
Overall life balance
NEED FOR LIFE BALANCE
- need to maintain and/or
rebuild an overall life balance
- need to learn to “live with”
an illness or disability
Does your hospitalisation have any repercussions
on the way you live usually?
Is your overall life balance disturbed by what is
happening to you now (hospitalisation, illness)?
Are you having difficulties coping with what is
happening to you now (hospitalisation, illness)?
How does the patient speak about his
or her need for life balance?
Is the overall life balance of this pa-
tient disturbed?
To what degree does the Need
for Life for Life Balance remain
unmet?
0 0
0 1
0 2
0 3
TRANSCENDENCE
Anchor point exte-
rior to the person
NEED FOR CONNECTION
- need for Beauty
- need to be connected with
the personal existential
anchor
Do you have a religion, a particular faith or spiritu-
ality?
Does what is happening to you now change your
relationship to God /or to your spirituality? (closer
to God, more distant, no change)
Is your religion / spirituality / faith challenged by
what is happening to you now?
Does what is happening to you now change or
disturb the way you live or express your faith /
spirituality / religion?
How does the patient speak about his
or her need for connection?
Is his or her need for connection
disturbed?
for Connection remain unmet?
0 0
0 1
0 2
0 3
VALUES
System of values
that determine
goodness and
trueness for the
person; the system
is made apparent
in the person’s
actions and life
choices
NEED FOR VALUES AC-
KNOWLEDGEMENT
- need that caregivers under-
stand what has value and
significance in his or her life
NEED TO MAINTAIN CON-
TROL
- need to understand and be
involved in caregivers’ deci-
sions and actions
Do you think that the health professionals caring
for you know you well enough?
Do you have enough information about your
health problem, and on the goals of your hospitali-
sation and treatment?
Do you feel that you are participating in the
decisions made about your care?
How would you describe your relationship with
the doctors and other health professionals?
How does the patient speak of his or
her need that caregivers understand
what has value and significance in his
or her life?
her need to understand and be in-
volved in caregivers’ decisions and
actions?
for Values Acknowledgement
remain unmet?
0 0
0 1
0 2
0 3
for to Maintain Control remain
unmet?
0 0
0 1
0 2
0 3
PSYCHO-SOCIAL
IDENTITY
The environment
(society, caregiv-
ers, family, close
relations) that
maintain the per-
son’s particular
identity.
NEED TO MAINTAIN IDENTITY
- need to be loved, to be
recognised
- need to be listened to
- need to be in contact (in
particular with the person’s
faith community and other
people)
- need to have a positive self-
image
- need to feel forgiven, to be
reconciled
Do you have any worries or difficulties regarding
your family or other persons close to you?
How do people close to behave with you now?
Does it correspond with what you expected from
them?
Do you feel lonely?
Could you tell me about the image you have of
yourself in your current situation (illness, hospitali-
sation)?
Do you have any links with your faith community?
her need to maintain identity?
for Maintain Identity remain
unmet?
0 0
0 1
0 2
0 3
0 = no evidence of unmet spiritual need;
1 = some evidence of unmet spiritual need;
2 = substantial evidence of unmet need;
3 = evidence of severe unmet spiritual need

(1) Cold Visit per Own Triaging Skills
Meaning Transcendence Values Psycho-Social Identity
Total ScoresLife Balance Need for Connection Acknowledgement Maintain Control Maintain Identity
1 2 1 3 3 2 11
2 1 1 1 1 1 5
3 1 1 2 2 1 7
4 1 1 1 1 1 5
5 1 1 1 1 1 5
6 1 2 1 1 1 6
7 2 1 3 3 2 11
8 1 1 1 2 1 6
9 2 1 1 1 2 7
10 2 1 1 1 1 6
11 3 1 2 2 1 9
12 2 1 2 2 0 7
13 1 1 1 1 0 4
14 1 1 1 1 1 5
15 1 1 0 0 1 3
16 1 1 1 1 0 4
17 1 1 0 0 0 0
18 1 0 2 2 1 6
19 1 1 1 1 0 4
20 1 1 0 0 1 3
21 1 1 0 1 1 4
22 1 1 2 2 1 7
23 1 1 2 2 1 7
24 1 1 2 2 1 7
25 1 0 1 1 0 3
Average (Mean) 1.3 1.0 1.3 1.4 0.9 5.7
(2) Referral Visit per Staff’s Referral
Meaning Transcendence Values Psycho-Social Identity
Total ScoresLife Balance Need for Connection Acknowledgement Maintain Control Maintain Identity
1 1 3 3 3 1 11
2 3 3 3 3 1 13
3 1 2 2 2 1 8
4 2 1 2 2 2 9
5 1 3 2 2 1 9
6 3 2 3 2 2 12
7 2 2 2 3 1 10
8 3 3 2 2 1 11
9 2 1 2 2 3 10
10 3 1 2 2 0 8
11 1 1 3 3 2 10
12 3 2 3 3 2 13
13 2 2 3 3 2 12
14 1 1 1 2 1 6
15 1 1 1 1 1 5
16 3 1 3 3 1 11
17 3 2 3 3 3 14
18 3 2 2 2 3 12
19 3 2 3 3 1 12
20 1 1 3 3 1 9
21 1 1 2 2 2 8
Average (Mean) 2.0 1.8 2.4 2.4 1.5 10.1
7. DATA COLLECTION

Spiritual Risk
Mean Score
Difference t stat p valueCold Visit Referral Visit
Need for Life Balance 1.3 2.0 0.7 3.363 <0.05
Need for Connection 1.0 1.8 0.8 4.411 <0.05
Need for Values Acknowledgement 1.3 2.4 1.1 4.938 <0.05
Need to Maintain Control 1.4 2.4 1.0 5.137 <0.05
Need to Maintain Identity 0.9 1.5 0.6 3.004 <0.05
Total Spiritual Risk Scores 5.7 10.1 4.4 6.306 <0.05
T-TEST: TWO INDEPENDENT SAMPLES (Cold Visit vs. Referral Visit)
Unequal Variances – Two Tail
 Unmet needs in referral based visit
shows significantly higher scores
than those of cold visit.
 4.4 points higher in total
 Need for Life Balance
 0.7
 Need for Connection
 0.8
 Need for Values Acknowledgement
 1.1
 Need to Maintain Control
 1.0
 Need to Maintain Identity
 0.6
* P Value < 0.05
8-1. DISTINCTIVE SPIRITUAL RISK IN TCU
5.7
10.1
High
Moderate
Mild
Low
ColdVisit ReferralVisit
SpritualRiskScores
(unmetneeds)
15

 Values Acknowledgement and Maintain to Control show higher scores
than other spiritual risks in both of referral based visit and cold visit
 It is related to the matter of Medical Information and Medical Treatment.
1.3
1.4
1.3
1
0.9
2.4
2.4
2.0
1.8
1.5
0 0.5 1 1.5 2 2.5 3
Acknowledgement
Maintain Control
Life Balance
Transcendence
Psycho-Social Identity
5 Spiritual RisksScores
Referral Visit
Cold Visit
 Personal Observation
-Delayed visits from medical doctor
-Lack or no enough medical information provided to patients
-Patient’s lower involvement in treatment options
 Research Articles
-Satisfaction with medical care by patients has become increasingly
important in today’s health care climate for many reasons.
-Gaps in understanding and communication between patients and
medical doctors could result in decreased quality of care.
8-2. DISTINCTIVE SPIRITUAL RISK IN TCU

9. COMMUNICATION DISCREPANCIES BETWEEN MD and PT *
NEVER
SOMETIMES
USUALLY
ALWAYS
*Adapted from Douglas P. Olson, MD; Donna M. Windish, MD: Communication Discrepancies Between Physicians and Hospi-
talized Patients, Arch Intern Med/VOL 170 (NO. 15), AUG 9/23, 2010
A. Did a doctor/medical staff provide new medicine information?
B. Did a doctor/medical staff provide medicine’s side effects information?
 Higher percentage of NEVER from patients vs. higher percentage of SOMETIMES from doctors
C. Did a doctor/medical staff invite patient to involvement in treatment options?
NEVER
SOMETIMES
USUALLY
ALWAYS
NEVER
SOMETIMES
USUALLY
ALWAYS
NEVER
SOMETIMES
USUALLY
ALWAYS
NEVER
SOMETIMES
USUALLY
ALWAYS
NEVER
SOMETIMES
USUALLY
ALWAYS
A. Did a doctor provide medical information in respectable way?
B. Did a doctor explain medical information in understandable way?
C. Did a doctor discuss about any Anxieties or fears about patient’s condition or treatment?

10. PATIENT’S RATING OF MEDICAL CARE *
Standard Care vs. Intervention Group
 The perceived length of stay (LOS) was significantly shorter
(92.6 vs. 105.5).
 The proportion of patients who
rated the ED staff physician as
“excellent” or “very good” was sig-
nificantly higher in the intervention
group (Bedside: 87.1% vs. 80.5 % /
Technical Skills: 86.8 % vs. 80.1 %)
 Periodic personal interaction and
provision of clinically based infor-
mation in ED is thought to improve
patient’s
perceived LOS, efficiency, and clinical skills of Emergency
Physicians after ED visit.
 The amount of information provided to patient and periodic
updating of process and medical information to patient have
effect on patient’s perception of care positively.
* Adapted from T. Paul Tran, MD; Warren P. Schutte, BS: Provision of Clinically Based Information
Improves Patients’ Perceived Length of Stay and Satisfaction with EP, Section of Emergency Medicine, Depart-

* By chance, I had a conversation with a physician whom I knew since
last year. The doctor was very proud of her specialty as a physician. I
have shared with her about my personal experimental research outcome.
I told her that I found out there was one distinctive unmet spiritual risk in
TCU.
I remarked that patient expressed their unmet needs caused by lower
quality of medical care from medical doctors. I told her that the cause of
unmet spiritual risks from medical service are as follows:
 Delayed visit from medical doctors
 No detailed/clear/understandable medical information from medical
doctors
 Few chances of patients’ involvement in medical decision making
process
The doctor agreed what I found out, but she shared the following per-
spectives from her clinical experience.
There is zero patient’s responsibility as a whole medical system
- “No return from patient”
- Physicians frustrated a lot because of patient’s complaint regardless
of their detailed information provided. For example, “You never told
me,” in response to “Did you read it.”; “Why angiogram now,” in re-
sponse to the procedure schedule; “I never know I have a kidney
problem,” even though doctor explained it a day ago.
- Physicians has “mad lists” on the desk.
- The doctor illustrated one palliative care patient’s daughter who
strongly denied DIALECTICS even though she explained it in detail
two days ago.
The doctor concluded patients need to be EDUCATED as life class to
lessen their unreasonable complaints.
From this conversation, I understand there are huge discrepancies be-
tween the perception of patient and that of medical doctors because of
various reasons.
11. A MEDICAL DOCTOR’S PERSPECTIVE

 When a person is admitted to a hospital, (s)he
must wear a gown, sleep in an unfamiliar bed and
take on the identity of the “patient.”
 Physician, as leader of the healthcare team, have
a professional and moral obligation to ensure that
patients feel welcome/comfortable/being
cared for in their new surrounding.
12. VALUE (MEDICAL CARE) RELATED SPIRITUAL
46-47%

Spiritual Distress Assessment Tool (SDAT)
Spiritual
Dimension
unmet spiritual need identified Unmet spiritual need
1st
visit (10) Last visit
(6)
Meaning -She is experiencing difficulty in breathing (demoralized).
-She needs to learn to live with new condition at Manor care facility.
-She lost her sister a month ago.
-Patient may experience difficulty from smoking withdrawal.
□ 0
□ 1
X 2
□ 3
□ 0
X 1
□ 2
□ 3
Transcen-
dence
-She is religious, faithful Catholic
-She values faith tradition (sacrament)
-She practices prayer every night
-She loves to hold rosary
-She loves to recite Hail Mary
-She is affiliated with local church
□ 0
X 1
□ 2
□ 3
X 0
□ 1
□ 2
□ 3
Values -She is experiencing physical distress in spite of medical treatment.
-She expresses her concern to Dr. R.
-She expresses her desire to allow her body to decline naturally.
□ 0
□ 1
X 2
□ 3
□ 0
X 1
□ 2
□ 3
-She kept on complaining about her breathing problem.
-She delegates most of medical treatment options to POA.
-She did not know POA’s intention beyond decision about Manor
care option itself.
□ 0
□ 1
X 2
□ 3
□ 0
□ 1
X 2
□ 3
Psycho-
Social
Identity
-She is proud of self-supportive life counting on pension.
-She denied support from her niece.
-She lost her sister a month ago.
-She welcomes chaplain’s visit.
-She needs to be reconnected to her son in spite of her disinterest.
-Her sons are not involved in her medical treatment decision making.
□ 0
□ 1
□ 2
X 3
□ 0
□ 1
X 2
□ 3
13. CASE STUDY
Spiritual risks changed from moderate (scores= 10) to mild (scores=6)
0 5 10 15
1stvisit
3rd visit
Case Study (Palliative Patient)
1stvisit
3rd visit
Patient’s unmet spiritual
needs decreased
from 10 to 6
(Moderate  Mild)
following 3 times palliative
spiritual care visits.
-Meaning (210)
-Transcendence (10)
-Acknowledgement (21)
-Maintain Control (22)
-Identity (32)

 One person’s experimental research
 Lack of Objectivity
 Small number of samples
̶ oold iisit Patients (25)
̶ eeferral iisit Patients (21)
 No Analysis of Demographic Factors
 Close professional relationship with other team
members
 Distinctive spiritual risks in TCU
 Values (Acknowledgment / Maintain Control)
 Medical Information/Communication Important
 Evidence of need (referral) based visit
 Chaplain as a juggler to handle multitask works
14. LIMITATION OF RESEARCH
15. FINDINGS OF RESEARCH

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