 | Tom Welk
DMin is Director of Pastoral Care & Professional Education at Harry Hynes Memorial Hospice. He also teaches at the University of Kansas School of Medicine-Wichita. He has certification with the American Association of Pastoral Counselors in Clinical Pastoral Education. His memberships include Park Ridge Center for Study of Health, Faith, and Ethics, and St. Louis University Center for Health Care Ethics, Charter Board Member Kansas Health Ethics, Inc., and Ethics Committee Member for National Hospice Organization. He has received the President's Award of Excellence for Public and Community Awareness, for the "Dying Well" project from The National Hospice Organization. Tom's group presentations include: Association of Kansas Hospices, Midwest Congress on Aging, and Kansas Health Ethics Conference. Tom Welk can be contacted by fax at (316) 265-6066, by e-mail at: twelk@hynesmemorial.org, or at his office at (316)219-1791. |
Hospice
2005-01-01 09:20:00
What are interdisciplinary teams?
: I've heard that hospice is delivered by a whole team of people, each with a different role, an interdisciplinary team. Why and what do the team members do?
ANSWER: First, we need to take a look at what is meant by health.Being "healthy" is generally understood as having a well functioning body --- no disease, no injury, no handicaps. Or at least a minimal amount of any of these compromising physical challenges.A brief look at the basic meaning of the word healthy indicates that this definition is too limiting. The first definition of "healthy" in Webster's dictionary is: "being in a sound state." Health is defined as "physical and mental well-being; soundness." I would expand this to include the concept of physical, psychosocial and spiritual well-being/soundness.The word healthy comes from the Anglo Saxon word hal, from which we derive the English word "whole." In other words, being healthy means we have good functioning not only in our physical component, but also in other aspects of human functioning, namely our psychosocial/spiritual makeup. Being healthy implies a wholistic concept.If being healthy means more than just maintaining physical well-being, then it follows that we must not only access the skills of those who are experts in taking care of our physical needs, but also the skills of those who are experts in taking care of our psychosocial/spiritual needs. It takes an interdisciplinary team to take care of human needs. Hospice emphasizes this interdisciplinary approach in providing services to terminally ill patients and their families. This team is made up of members who are skilled in addressing physical needs, providing emotional support, resolving family concerns and dealing with spiritual issues.1) Physical needs: Patients admitted to the care of a hospice program have exhausted the possibility of benefiting from aggressive curative interventions. The focus now will be on providing maximum comfort, i.e., pain control and symptom management (shortness of breath, nausea, vomiting, etc.). This care is given by doctors, nurses, health care aides and others as needed. Many hospice programs require that these staff members be certified in palliative (comfort) care. In choosing a hospice program, readers may want to ask if that is the case for the program they are considering.2) Emotional support: Facing something unknown or not previously experienced is uncomfortable. Death is the greatest unknown. As a fearful patient recently told me, "But I haven't died before." None of us has died before. Talking to someone about these fears and other emotional/psychological issues can bring about a great deal of peace. This is the role of the social worker on the hospice interdisciplinary team.3) Family concerns: In most medical settings the "client" is the patient receiving care. In hospice the "client" is both the patient and the family. Death is not a totally private affair. Every death has an impact on a wider circle; the extent of the ripple effect varies from one family unit to another. Often patients feel they are being a burden because of the demanding care required for them; or they feel guilty about the pain that their death will cause loved ones. Knowing that family/loved ones are getting support is a great source of peace for the terminally ill patient. This family support is given by a variety of team members, depending on what issues arise. Nurses explain and teach about remedies to address physical challenges; social workers identify resources to assist the family; volunteers provide respite; chaplains address religious/spiritual issues.4) Spiritual issues: Defining what is meant by "spiritual" is difficult. The tendency is to make it synonymous with religion. Spirituality comes down to one's search for meaning and purpose. Human beings have a profound need to make sense out of life. Asking "why?" is intimately tied up with human existence. Being connected with a formal religious group is one avenue many use to explore the "why" questions. Patients whose dying is imminent struggle with the question of the meaning of death. For those patients not having a church/religious connection hospice provides chaplains who walk with them on this last part of their life's journey. The hospice chaplains do not engage in proselytizing or convert making. Their responsibility is to walk with the patient and/or family in the ways they prefer.The above outlines the hospice interdisciplinary team and its responsibilities. Not only are physical needs addressed, but also the other needs that define what it means to be human. I began my comments with the basic definition of what it means to be healthy: sound physical, psychosocial and spiritual functioning. This is what makes us whole.This definition also gives us an understanding of the difference between cure and heal. Cure ties in to the efforts expended to maintain soundness in physical functioning. Eventually, every human being will become incurable. The basic root meaning of heal (hal) is to make whole. We may exhaust the possibility of cure, but we will never exhaust the possibility of being healed.The hospice interdisciplinary team is there to provide whatever support it can to enable healing/wholeness/growth to the very last breath. And, to weave in a faith dimension, doing so with the belief that death is the ultimate healing.
