Course 4:

Strategies for Spiritual Care in a Health Care Setting

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Whole Person Care Program

Course 1

Understanding Health & Healing

Course 2

Motivation for Spirituality in Health Care

Course 3

Personal, Environmental, & Staff Preparation for Whole Person Care

Course 4

Strategies for Spiritual Care in a Health Care Setting

Course 5

Living & Maturing as a Christian Health Care Professional

Resources

Course Resources

Course 4

Image to represent course 3 - puzzle piece

Strategies for Spiritual Care in a Health Care Setting

Course Outline

Preparing and Equipping the Team
Staff and Volunteer Involvement in Spiritual Care
Taking a Spiritual History in the Exam Room
Elements of Spiritual Care in the Exam Room
Spiritual Follow-up at Subsequent Visits
Ethical Considerations for Patient Interactions

Topic 1

Preparing and Equipping the Team

Personal Preparation

Personal preparation could include various elements of worshipping the Lord, such as

Prayer, especially for spiritual protection
Scripture reading
Spiritual songs

Empty yourself of your personal agenda, consider each visit as a divine appointment, and open yourself to the working of the Holy Spirit in and through you.

How you prepare for this work is personal. Ask God to use you. As Isaiah said, "Here I am! Send me."
Personal preparation can include various elements of worshipping the Lord, such as: prayer, scripture reading, and spiritual songs.
Psalm 143:8 says, "Let me hear in the morning of your steadfast love, for in you I trust. Make me know the way I should go, for to you I lift up my soul."
When you enter into God's work, pray especially for spiritual protection. Remember Ephesians 6:12, "For we do not wrestle against flesh and blood, but against the rulers, against the authorities, against the cosmic powers over this present darkness, against the spiritual forces of evil in the heavenly places."
Empty yourself of your personal agenda, consider each visit as a divine appointment, and open yourself to the working of the Holy Spirit in and through you. Galatians 5:25 says, "If we live by the Spirit, let us also keep in step with the Spirit."

Team Spiritual Preparation

Equally important for the staff and volunteers to be prepared for the day with corporate devotions and prayer.

“For where two or three have gathered together in My name, I am there in their midst.”

Matthew 18:20 (NASB)

Image representing a Mindset for Providing Spiritual Care - prayer icon

Teamwork

Bring staff and volunteers together to remind them

God is at work in the community
They are called to come alongside to honor and glorify God
Every patient is an image bearer of God
Patient interactions with them can affect a patient's openness to spiritual care
Everyone has a role in spiritual care

On a regular basis, bring all staff and volunteers together to review the vision and the mission of your ministry.
Remind them that God is at work in the community and that they have been called to come alongside to honor and glorify Him.
Recognize that every patient is an image bearer of God and should be treated with human value and dignity.
Positive experiences with staff and volunteers can prepare the patient to open up to the provider, chaplain, counselor, or other staff members who later have extended conversations with the patient.
Conversely, negative experiences can also affect a patient’s willingness to engage in spiritual care.
Everyone has a role in spiritual care, and all roles are important! 1 Corinthians 12:12 says, "For just as the body is one and has many members, and all the members of the body, though many, are one body, so it is with Christ."

Woman taking notes while reading a Bible

Motivation for Spiritual Care

Scientific evidence for the positive health benefits of spirituality is robust.
Secular accrediting and professional organizations require it.
Most patients want it.
It is ethical, when provided in a patient-centered manner.
Above all, the Bible compels it.

Facility Enhancements for Spiritual Care

“Look carefully then how you walk, not as unwise but as wise, making the best use of the time…”

Ephesians 5:15-16 (ESV)

To the extent possible, it is helpful for patients to be prepared for spiritual care.
This can be accomplished by what they see and hear as they enter the faith-based health care facility.
Keep in mind Ephesians 5:15-16, "Look carefully then how you walk, not as unwise but as wise, making the best use of the time..."
The Neighborhood Christian Clinic has found that branding is important, so they included the word "Christian" in the organization's name on the signage and other materials.
The Neighborhood Christian Clinic has also found that the following practices have made a difference in their organization:
• Displaying crosses outside of and throughout the facility,
• Placing Bibles in the waiting areas and exam rooms,
• Having Scripture verse cards dispensed with medications,
• Having Scripture displayed in the common areas, reception counter, and exam rooms—even on each door,
• Playing Christian music in the waiting areas,
• Displaying artwork that reflects Christian values, as well as reflecting the community culture,
• Placing Christian reading materials in common areas,
• And having a prayer request basket available for patients, volunteers, and staff.

Preparing and Equipping the Team: Reflection

What will spiritual preparation look like for your role in your organization?

What will spiritual preparation look like for your group or team?

What facility enhancements will you incorporate?

Topic 2

Staff and Volunteer Involvement in Spiritual Care

Building Rapport

Building rapport with patients will enhance the organization’s ministry of providing spiritual care.

First impressions say a lot!
Communicate that you value each patient.
Make eye contact, smile, use their name, and be welcoming.
Engage in conversation.

Screening for Spiritual Needs

Spiritual care screening tool
Prayer request cards

For a screening tool and prayer request cards, go to the “Resources” of this Whole Patient Care Curriculum.

Effective Spiritual Conversations

Follow the promptings of the Holy Spirit.

Respond to the concerns of the patient with love.

Be ready to share how God has worked in your life.

Utilize faith flags and faith stories.

“… Always be prepared to give an answer to everyone who asks you to give the reason for the hope that you have. But do this with gentleness and respect …”

1 Peter 3:15 (NIV)

Power of Spiritual Partnerships

Outside organizations:

Local churches
Chaplains
Prayer teams

Staff and Volunteer Involvement in Spiritual Care: Reflection

What is your rapport like with those you work with in your health care setting?

What screening tools does your health care facility already use? What others could be implemented?

When providing care to your patients, what has the Holy Spirit prompted you to say or to do for your patient? What was the result of following or not following that prompting?

What spiritual partnerships do you and your health care facility have?

Topic 3

Taking a Spiritual History in the Exam Room

Overview of a Spiritual History in the Exam Room

Purpose of spiritual history:

Identifies the patient’s spiritual background and where they are
Opens the door to provide patient-centered spiritual care

Elements of a Spiritual History

Role God plays in the patient’s life
Connections with family, friends, and faith community
Spiritual beliefs that conflict with or enhance care
Specific spiritual needs to be addressed
Areas of brokenness and how they complicate their illness

Strategies for Taking a Spiritual History

Using a medical or social history as a bridge to a spiritual history
Asking opening questions and following the prompting of the Holy Spirit
Listening and looking for and employing faith flags
Identifying patient sources of strength and burdens

Strategy: Bridge to a Spiritual History

Use a medical or social history as a bridge to a spiritual history

Listen for spiritual needs and stressors (social, emotional, or medical).
Ask them how they are coping with identified stressor.
Then ask them whether they have a faith that has helped them with that issue, if they pray about that, if they seek God’s help with that, or other spiritual questions.

First let's look at the strategy of using the medical or social history as a bridge to the spiritual history.
While you are taking a medical or social history, a patient may reveal spiritual needs.
While you are taking a medical or social history, listen for areas of stress.
Stressors can be social, emotional, or medical. They could be marital stress, depression, or chronic pain, to name a few.
When a stressor is identified, you can ask how they are coping with that stressor. You can then ask whether they have a faith that has helped, if they pray about the issue, or if they seek God's help.
You may also ask other spiritual questions. There is no one set of questions, but it is necessary to listen to the patient and the prompting of the Holy Spirit to better understand the patient's spiritual health.

Example 1
Bridge to a Spiritual History

Example 2
Bridge to a Spiritual History

Strategy: Opening Questions and Prompting of the Holy Spirit

When no stressor is identified from the medical or social history, take a basic spiritual history by asking opening questions and then follow the prompting of the Holy Spirit:

Have questions that you are comfortable with to open up spiritual conversations.
Pray for the Holy Spirit to guide you.

There are times when no stressors have been identified.
Even if the patient does not reveal any spiritual needs in their medical or social history, you will still take a spiritual history. In order to do so, you will need to have questions that you are comfortable with in order to help open up spiritual conversations.
Asking the first question can be challenging or uncomfortable; pray for the Holy Spirit to guide you. The more you ask these types of questions, the easier it will become.
When we ask spiritual questions, we don’t know the hearts of people, but the Holy Spirit does.
Let the Holy Spirit guide you to adapt as the conversation progresses. Anticipate the nudge or prompt that will lead to the next question. Asking questions in faith will open the door for further questions and spiritual discussion.

Example 3
Opening Questions and Prompting of the Holy Spirit

Strategy: Faith Flags

Listen and look for faith flags:

A brief mention or statement about God, the Bible, or prayer
Tattoos, jewelry, or other physical items that are religious in nature

Example 4
Faith Flags

Faith Flags

Employ faith flags yourself!

Image depicting various strengths and burdens

Doctor listening to a married couple as they hold hands during a patient visit

Strategy: Sources of Strength and Burdens

Identify a patient’s sources of strength and burdens by asking questions to learn about…

Their trust or distrust of God
Programs or mentors that have been a source of support
Burdens that hinder progress
Strategies used to cope
Barriers to coping with stressors

Strategy: Sources of Strength and Burdens

Listen in the power of the Holy Spirit with curiosity and without judgement, and listen with your heart to hear the “lament of the soul.”

The last strategy that we will discuss is inspired by Dr. Harvey Elder, a distinguished professor of infectious disease at Loma Linda University.
He challenges health care professionals to ask questions to assess the patient's strengths and burdens.
He encourages that we ask questions to learn about…
• Their trust or distrust of God,
• What programs or mentors have been a source of support,
• What burdens hinder their progress,
• How the patient copes with stressors, such as exercise, diet, sleep, relationships, meditation, spirituality, etc.,
• And what impedes their ability to cope with stressors.
While asking these questions, listen in the power of the Holy Spirit with curiosity and without judgement.
Listen with your heart to hear the "lament of the soul" as they reveal past failures, present fears, and future hopelessness.

Taking a Spiritual History in the Exam Room: Reflection

What is a set of possible questions that you can ask when you take a spiritual history?

What are possible questions that you can ask when you see a faith flag?

Topic 4

Elements of Spiritual Care in the Exam Room

Elements of Spiritual Care

Some of the ways to deliver spiritual care are…

Offering prayer
Offering wise counsel

Sharing Scripture
Sharing faith stories
Referring to a local church and counselors

Sharing the gospel

When you offer spiritual care, it is important to first obtain permission from the patient.

Elements of Spiritual Care: Prayer

Why pray with patients?

Patients tend to be very accepting of prayer in the privacy of an exam room.
When prayer is offered, patients often reveal needs that were not shared during the spiritual history.
Prayer can provide God’s peace and comfort to the patient.
It is also an opportunity to convey elements of the gospel as well as lead to spiritual conversations.

Elements of Spiritual Care: Prayer (continued)

Use the patient’s native language, if possible.
If everyone is comfortable, hold hands or touch a shoulder.
Use the patient’s name.
Focus prayer on adoration, thanks, forgiveness, or specific requests.
When closing, you can end with “in the name of Jesus.”

Remember that prayer is talking with God and building a relationship with Him. Prayer does not need to be complicated or use fancy language. It can be as simple as having a respectful conversation with a friend.
• Use the patient's native language, if possible. Prayer in any language glorifies God. Avoid using Christian jargon to minimize misunderstanding.
• If everyone is comfortable, hold hands or touch a shoulder.
• Use the patient's name.
• Focus prayer on adoration, thanks, forgiveness, or specific requests. A few examples are:
• We praise you for your creation, your love, and your strength.
• Thank you, God, that you have the power to heal us.
• God, thank you that you forgive our sins when we put our faith in Jesus.
• We ask that you bring healing, peace, comfort, and remove pain.
• We ask that you to give us faith and guide us.
• When closing, you can end with "We pray these things in the name of Jesus."

Video:

Conversation About Praying With Patients

Elements of Spiritual Care:
Wise Counsel

Scripture

Wise counsel can include reading or recommending Scripture.

Scripture cards
Christian and Bible tracts
Bibles
Note with Bible verse(s)

For Scripture card PDFs and tracts, go to the “Resources” of this Whole Patient Care Curriculum.

Video:

Scripture

Faith Stories

Faith story shared by health care professional with patient

Describes a personal encounter with God
Communicates spiritual truth
Demonstrates how God is at work

Video:

Faith Stories

Referral to Local Church and Counselors

Get to know the community you serve and create a list for distribution with

Local Bible believing churches that have opportunities for spiritual growth
Faith-based or Christian counselors that are aligned with biblical principles

Elements of Spiritual Care: Gospel

Become comfortable with a method for sharing the gospel.

1 Peter 3:15 – Always be prepared to give an answer
Sharing the gospel is an act of obedience when prompted by the Holy Spirit
Successful witnessing is simply sharing the gospel in the power of the Holy Spirit and leaving the results to God

Taking a spiritual history, praying, and sharing wise counsel can lead to sharing the gospel or cultivate receptivity to the gospel.
Are you comfortable sharing the gospel when the Holy Spirit leads you?
It helps to become comfortable with a method for sharing the gospel.
Often time is limited, and having a method helps you organize the essentials with a beginning and an end.
As a health care professional, you learn patterns of thinking, systems of diagnosis, and methods for how you do procedures.
Would Christ expect anything less in the provision of spiritual care?
When you share the gospel, remember:
• 1 Peter 3:15 says, "… Always be prepared to give an answer to everyone who asks you to give the reason for the hope that you have. But do this with gentleness and respect …"
• Sharing the gospel is an act of obedience when prompted by the Holy Spirit, and
• Successful witnessing is simply sharing the gospel in the power of the Holy Spirit and leaving the results to God.

Key Elements of the Gospel

God loves you and offers a great plan for your life.
God is holy and just, and we are all separated from Him by our sin.
God is merciful and provided His son Jesus as the only payment for our sin.
Salvation is personal, and God waits to credit this payment to us until we repent and personally receive Jesus as Lord and Savior.

For related Bible passages, go to the “Resources” of this Whole Patient Care Curriculum.

Methods for Sharing the Gospel

The “Gospel” scripture card
Four Spiritual Laws
Romans Road
3 Circles
G.O.S.P.E.L.

For links to these methods, go to the “Resources” of this Whole Patient Care Curriculum.

With these key elements in mind, there are many established methods for sharing the gospel. Here are few that may be helpful.
• The "Gospel" scripture card, created by The Neighborhood Christian Clinic, is found in the Scripture racks at the clinic and can be printed and downloaded for free.
• Four Spiritual Laws, by Cru, is a simple and systematic way to present the gospel message.
• Romans Road, from the Teen Missions International, Incorporated website, is a method that focuses on gospel passages from the book of Romans.
• 3 Circles, developed by the North American Mission Board, is a unique visual method to present the gospel. And…
• "G.O.S.P.E.L." by the artist Propaganda, from I Am Second and Dare 2 Share. This is a 5-minute rap-style video of the gospel story.
For links to these methods, go to the "Resources" of this Whole Patient Care Curriculum.

Methods for Sharing the Gospel (continued)

Have resources readily available, hard copy or app
Remember Jesus said you will be either sowing or reaping
Share in the power in the Holy Spirit
Applicable with patients and anyone in your life

Tips for Spiritual Care

Remember:

God is in charge
When a patient hesitates to listen, don’t press the issue.
Stay on target: Christ is the gospel.
Recognize that your encounter with the patient is a divine appointment
Assure the patient they are loved, accepted, and valued
Spiritual care is about obedience

Elements of Spiritual Care in the Exam Room: Reflection

What has been your experience when you have prayed with a patient?

What resources can you use to share Scripture in your office?

What faith stories can you share with patients?

What methods will you use to share the gospel?

Topic 5

Spiritual Follow-Up at Subsequent Visits

Documentation for Ongoing Spiritual Care of Patients

Example of notes that can be documented in the spiritual history are

• Active Christian faith, reads the Bible
• Believes in God, but no particular religion
• Angry with God
• Left childhood faith because of hypocrites

• Prayer offered and received
• Scripture related to grief offered and received

In order to provide follow-up care for a patient's spiritual needs, ongoing documentation in the spiritual history and in the summary of care is helpful.
A few examples of notes that can be documented in the spiritual history are
• active Christian faith, reads the Bible, or
• believes in God, but no particular religion, or
• angry with God, or
• left childhood faith because of hypocrites
Even if you were not the provider that charted the comments, you can base your follow-up questions on the notes taken.
For example, "Last time you were here you shared that you were angry with God. May I ask how you are feeling today?"

When spiritual care is provided, examples of notes that can be documented in the summary of care are
• Prayer offered and received, or
• Scripture related to grief offered and received

Doctor holding a screening tool for a patient

Primary care provider asking a patient questions

Providing Ongoing Spiritual Care

Before a primary care provider sees a patient in the exam room,

Offer a spiritual care screening tool
Review the patient’s spiritual history, the previous spiritual care provided, and the assessment tool

For a spiritual care screening tool, go to the “Resources” of this Whole Patient Care Curriculum.

Providing Ongoing Spiritual Care

In the exam room, the primary care provider can

Ask follow-up questions related to past and new spiritual needs
Check on life and current stressors that may impact their relationship with God
Offer spiritual care for identified issues
Look for opportunities to pray to God
Look for opportunities to share faith stories, Scripture, and the gospel

Ongoing Spiritual Care for Christians

Questions that assess a Christian’s spiritual growth:

Do you read the Bible at home?
Do you have joy, peace, and strength?
Do you enjoy sharing your faith with others?
Are you serving the Lord in any capacity?
Are you engaged in ongoing Christian fellowship and corporate worship?

Spiritual Follow-up at Subsequent Visits: Reflection

Which of them are ones that you would use?

What questions would you ask?

Topic 6

Ethical Considerations for Patient Interactions

Ethical Basis for Spiritual Care in the Exam Room

Image representing Beneficence Justice and Autonomy - Only need three pieces to make a whole!

Ethical Patient-Centered Conversations in the Exam Room

Guidelines for patient-centered conversations:

When obtaining permission to provide spiritual care, ask in a way that allows for the patient to say “no”
Show concern by maintaining eye contact, if appropriate
Look and listen for nonverbal as well as verbal cues and never appear rushed
Show respect for the patient as God’s precious child
Do not be condescending; use the language of the patient
Speak words of love, acceptance, forgiveness, and assurance

In patient-centered care, the patient and provider work together to address the patient's overall health needs.
In this collaborative relationship, a patient's responses provide the boundaries of the conversation, which implies that permission is necessary prior to delivering spiritual care.
The staff at The Neighborhood Christian Clinic have found the following guidelines helpful for having patient-centered conversations:
• When obtaining permission to provide spiritual care, ask in a way that allows for the patient to say "no," and be willing to accept that as an answer.
• Show concern by maintaining eye contact, if appropriate.
• Look and listen for nonverbal as well as verbal cues and never appear rushed. Be sensitive to fatigue or indifference.
• Show respect for the patient as God's precious child.
• Do not be condescending; use language appropriate for your patient’s level of understanding.
• Speak words of love, acceptance, forgiveness, and assurance.

Unethical Spiritual Care

Be careful to avoid unethical ways of providing spiritual care:

Denying a patient the right to refuse spiritual care
Sharing biblical truth without permission
Suggesting that receipt of further medical care is dependent on listening to a spiritual presentation
Rationing medical care according to response to spiritual care
Focusing exclusively on spiritual care
Having a personal agenda

Ethical Considerations for Patient Interactions: Reflection

Think back to conversations you have had with someone who has a different belief system than you.

How did you feel when you were pressured to engage in a conversation with them?

Think about the conversations Jesus had with others.

How did He draw people into spiritual conversations?

Course Conclusion

References can be found in the

“Resources”

for this Whole Person Care Curriculum.

Thank you!

Please click the next page arrow to complete the end-of course survey and receive your certificate!

Course 4: Strategies for Spiritual Care in a Health Care Setting

Course 4: Strategies for Spiritual Care in a Health Care Setting

Keyboard Shortcuts

Keyboard Shortcuts

Course Instructions

Introduction

Whole Person Care Program

Course 1

Course 2

Course 3

Course 4

Course 5

Resources

Strategies for Spiritual Care in a Health Care Setting

Course 4

Strategies for Spiritual Care in a Health Care Setting

Topic 1: Preparing and Equipping the Team

Topic 1 Preparing and Equipping the Team

Personal Preparation

Personal Preparation

Team Spiritual Preparation

Team Spiritual Preparation

Matthew 18:20 (NASB)

Teamwork

Teamwork

Motivation for Spiritual Care

Motivation for Spiritual Care

Facility Enhancements for Spiritual Care

Facility Enhancements for Spiritual Care

Ephesians 5:15-16 (ESV)

Preparing and Equipping the Team: Reflection

Preparing and Equipping the Team: Reflection

Topic 2: Staff and Volunteer Involvement in Spiritual Care

Topic 2 Staff and Volunteer Involvement in Spiritual Care

Building Rapport

Building Rapport

Screening for Spiritual Needs

Screening for Spiritual Needs

Effective Spiritual Conversations

Effective Spiritual Conversations

1 Peter 3:15 (NIV)

Power of Spiritual Partnerships

Power of Spiritual Partnerships

Staff and Volunteer Involvement in Spiritual Care: Reflection

Staff and Volunteer Involvement in Spiritual Care: Reflection

Topic 3: Taking a Spiritual History in the Exam Room

Topic 3 Taking a Spiritual History in the Exam Room

Overview of a Spiritual History in the Exam Room

Overview of a Spiritual History in the Exam Room

Elements of a Spiritual History

Elements of a Spiritual History

Strategies for Taking a Spiritual History

Strategies for Taking a Spiritual History

Strategy: Bridge to a Spiritual History

Strategy: Bridge to a Spiritual History

Example 1: Bridge to a Spiritual History

Example 1 Bridge to a Spiritual History

Example 2: Bridge to a Spiritual History

Example 2 Bridge to a Spiritual History

Strategy: Opening Questions and Prompting of the Holy Spirit

Strategy: Opening Questions and Prompting of the Holy Spirit

Example 3: Opening Questions and Prompting of the Holy Spirit

Example 3 Opening Questions and Prompting of the Holy Spirit

Strategy: Faith Flags

Strategy: Faith Flags

Example 4: Faith Flags

Example 4 Faith Flags

Faith Flags

Faith Flags

Strategy: Sources of Strength and Burdens

Strategy: Sources of Strength and Burdens

Strategy: Sources of Strength and Burdens

Taking a Spiritual History in the Exam Room: Reflection

Taking a Spiritual History in the Exam Room: Reflection

Topic 4: Elements of Spiritual Care in the Exam Room

Topic 4 Elements of Spiritual Care in the Exam Room

The Board and the Mission

Elements of Spiritual Care

Elements of Spiritual Care: Prayer

Elements of Spiritual Care: Prayer

Course 4:

Strategies for Spiritual Care in a Health Care Setting

Topic 1

Preparing and Equipping the Team

Topic 2

Staff and Volunteer Involvement in Spiritual Care

Topic 3

Taking a Spiritual History in the Exam Room

Example 1
Bridge to a Spiritual History

Example 2
Bridge to a Spiritual History

Example 3
Opening Questions and Prompting of the Holy Spirit

Example 4
Faith Flags

Topic 4

Elements of Spiritual Care in the Exam Room

Elements of Spiritual Care:
Wise Counsel

Topic 5

Spiritual Follow-Up at Subsequent Visits

Topic 6

Ethical Considerations for Patient Interactions