Volume 15, Issue 3, September 2004   
     
Coordinator’s Message
Spiritual Care Requires Integrity

Marilyn Tuls Halstead, RN, PhD, AOCN®
Westminster, MD
mhalstead@towson.edu


Although many of you are acquainted with my name because of previous positions I have held in the Spiritual Care SIG, some of you are new members (actually quite a few!), and I am new in the position of coordinator. I look forward to serving our SIG and profession by encouraging dialogue, thinking, and action in the area of spiritual care for patients with cancer. However, no one can do this without the help of many. So I encourage your participation in any way. What are your needs? How can the SIG become a meaningful part of your life and career? Let us know. Contact any one of the officers listed on the last page of this newsletter.

The coordinator usually writes a few lines in the newsletter, and I will try to continue that custom. In thinking of a theme for writing my thoughts, I decided that I would look at the core values of ONS and relate them to spiritual care. To refresh your memory, I will include the following paragraphs about the core values and then briefly discuss the value for this newsletter: integrity.

  
 

Special Interest Group Newsletter  September 2004
 
   


Coordinator’s Message
Spiritual Care Requires Integrity
Marilyn Tuls Halstead, RN, PhD, AOCN®
Westminster, MD
mhalstead@towson.edu


Although many of you are acquainted with my name because of previous positions I have held in the Spiritual Care SIG, some of you are new members (actually quite a few!), and I am new in the position of coordinator. I look forward to serving our SIG and profession by encouraging dialogue, thinking, and action in the area of spiritual care for patients with cancer. However, no one can do this without the help of many. So I encourage your participation in any way. What are your needs? How can the SIG become a meaningful part of your life and career? Let us know. Contact any one of the officers listed on the last page of this newsletter.

The coordinator usually writes a few lines in the newsletter, and I will try to continue that custom. In thinking of a theme for writing my thoughts, I decided that I would look at the core values of ONS and relate them to spiritual care. To refresh your memory, I will include the following paragraphs about the core values and then briefly discuss the value for this newsletter: integrity.

Core Values of ONS and Affiliated Corporations (www.ons.org/about/corevalues.shtml)
When all else changes, values endure. Values are our organizations’ guiding principles. They represent our core beliefs for the Oncology Nursing Society (ONS) and its family of affiliated corporations, including the ONS Foundation, Oncology Nursing Certification Corporation, and Oncology Education Services, Inc. The ONS values serve to guide our leaders and members. All are encouraged to assign their personal meaning to each of these words, for values are beliefs, both personal and collective. The explanatory phrases with each value are meant as guides for understanding. These phrases should neither limit the intent of the value nor serve as a definition.

INNOVATION
ONS and its members face every endeavor with creativity and knowledge. We strive to apply our broad perspectives consistently while leading the transformation of cancer care.

STEWARDSHIP
We are committed to protecting and nurturing the resources of the members and the organization. We do this through judicious and prudent use of all of our financial resources and the time and talents of our members and staff. We are accountable to the members and the public to nurture and grow our human and financial assets.

ADVOCACY
We, as an organization and as individuals, advocate on behalf of people with cancer to ensure their quality of life and their access to exemplary care throughout the continuum of life. We advocate on behalf of the nursing profession and the oncology specialty to ensure respect and recognition, access to education, safe working environments, and fair reimbursement. We also serve as advocates for public policy, particularly in matters of health.

EXCELLENCE
We strive to foster excellence in clinical practice, research, education, and administration. We are committed to nothing less than excellence in our organization and the care of patients.

INCLUSIVENESS
We celebrate and support diversity of thought and of individuals. We strive for a culturally, ethnically, and racially diverse membership to strengthen our ability to meet the needs of everyone we serve.

INTEGRITY
The organization and its members exhibit integrity and earn trust through ethical behaviors and uncompromising professionalism to all parties in business, professional, and personal interactions.

This core value is easy to relate to spirituality, isn’t it? How can it be otherwise? After all, we’re nurses, aren’t we? And nurses “exhibit integrity and earn trust,” right? We all know that in order to “nurse” people, we have to earn their trust. We can’t even begin the nurse-patient relationship until trust is established. And nurses are the most trusted professionals, according to a Gallup Poll. But is integrity more than trust? More than ethical behaviors, accountability, and nurturance?

To answer that question, perhaps it is necessary to look at the roots of the term. According to Webster’s Dictionary, integrity is

  1. The quality or state of being complete; unbroken condition; wholeness; entirety.
  2. The quality or state of being unimpaired; perfect condition; soundness.
  3. The quality or state of being of sound moral principle; uprightness, honesty, and sincerity.
Not much is newsworthy in the definition. However, when we look at the etymology of the term, it becomes more interesting. The word originated in Latin (integritas) and evolved in middle English to integrite and is related to the term integer. Mathematically, at least, the term integer means whole. Ah-ha! So there is much more to integrity than simple trust or earning trust.

Integrity is a spiritual concept. It implies wholeness, and nurses know that nursing has to be holistic to be effective. One cannot treat only the body. Nursing entails treating the mind and spirit in addition to the body. The reason, of course, is that the human cannot be separated into parts.

But I am repeating what you already know, or why would you be involved in the Spiritual Care SIG? Our job then is to practice spiritual care in a way that reflects this knowledge and educates our colleagues about the need for spiritual care because it exemplifies one of the core values of ONS.

One more thought: Is it possible to provide spiritual care with integrity? To do so, must I be a whole person (whole in the sense of complete)? I don’t know about you, but there are days when I don’t feel particularly whole. Perhaps a silly question, but the point is that I’m on a spiritual journey, and that means that I don’t have all of the answers. I’m a seeker, too. By acknowledging this fact, I can relate to my patients with integrity. A little humility sets the stage, encourages honest conversation and acceptance of others (regardless of their position on the spiritual journey), and, yes, establishes trust.
 
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Special Interest Group Newsletter  September 2004
 
   


Editor’s Note
Palliative Care Is A Gift

Tami Borneman, RN, MSN, CNS
Derwood, MD
tbornema@earthlink.net


Webster’s New World Dictionary (Neufeldt & Guralnik, 1994) defines gift as

  1. Something given to show friendship, affection, support, etc.
  2. The act, power, or right of giving.
  3. A natural ability; talent.
The World Health Organization (WHO) (2002) defines palliative care as the “active total care of patients whose disease is not responsive to curative treatment.” Providing palliative care is not just our duty as healthcare providers, but also an act of giving. Our jobs dictate what we give, how much, when, and in what manner, but it is from our hearts that we give of ourselves.

I first want to share a story, followed by a poem written by a family caregiver of a patient who died from cancer. The story, although it involves two patients, exemplifies what we, as nurses, provide to patients and their family caregivers. As you read the story, perhaps you can think of times when you have provided the gift of sight or vision or comfort to an emotionally dry patient.

Bed With a View
By G.W. Target

There were once two men, both seriously ill, in the same small room of a great hospital. Quite a small room, just large enough for the pair of them—two beds, two bedside lockers, a door opening to the hall, and one window looking out on the world.

One of the men, as part of his treatment, was allowed to sit up in bed for an hour in the afternoon (something to do with draining the fluid from his lungs), and his bed was next to the window. But the other man had to spend all of his time flat on his back, and both of them had to be kept quiet and still. Which was the reason they were in the small room by themselves, and they were grateful for peace and privacy, none of the bustle and clatter and prying eyes of the general ward for them.

Well, they used to talk for hours and hours, about their wives, their children, their homes, their jobs, their hobbies, their childhoods, what they did during the war, where they had been on vacations, and all of that sort of thing. Every afternoon, when the man in the bed next to the window was propped up for his hour, he passed the time by describing what he could see outside. And the other man began to live for those hours.

The window apparently overlooked a park with a lake where there were ducks and swans, children throwing them bread and sailing model boats, and young lovers walking hand in hand beneath the trees. There were flowers and stretches of grass, games of softball, people taking their ease in the sunshine, and, right at the back, behind the fringe of trees, a fine view of the city skyline.

The man on his back listened to all of this, enjoying every minute—how a child nearly fell into the lake, how beautiful the girls were in their summer dresses, then an exciting ball game, or a boy playing with his puppy. He could almost see what was happening outside.

Then one fine afternoon, during some sort of parade, the thought struck him: Why should the man next to the window have all of the pleasure of seeing what was going on? Why shouldn’t he get the chance? He felt ashamed and tried not to think like that, but the more he tried, the worse he wanted a change. He’d do anything!

In a few days, he had turned sour. He should be by the window. And he brooded and couldn’t sleep and grew even more seriously ill, which none of the doctors understood. One night, as he stared at the ceiling, the other man suddenly woke up coughing and choking, the fluid congesting in his lungs, his hands groping for the button that would bring the night nurse running. But the man watched without moving. The coughing racked the darkness—on and on, choked off, then stopped, the sound of breathing stopped—and the man continued to stare at the ceiling.
In the morning, the day nurse came in with water for their baths and found the other man dead. They took away his body quietly, no fuss. As soon as it seemed decent, the man asked if he could be moved to the bed next to the window. They moved him, tucked him in, made him quite comfortable, and left him alone to be quiet and still.

The minute they had gone, he propped himself up on one elbow, painfully and laboriously, and looked out the window.

It faced a blank wall.

We all know that the night nurse would have known about the patient dying before morning. However, that is not the focus here. The focus is the gift that the man provided to his roommate, a selfless act of giving. Every time we help patients find meaning in their illness, every time we help patients redirect their hope, every time we haggle with insurance companies, every time we share joy with patients, every time we share in their sometimes endless emotional solitude, every time we affirm the gift of who they are, every time we … you fill in the blank, we provide a gift. This is true palliative care, for it goes beyond even comfort care. It is a selfless compassion that puts others before self. The following poem says it well.

To the Nurses of the World
Written by a family caregiver, John Wayne Schlatter

You evangelists of encouragement, you are so much more than you know.
You have never let what you couldn’t do stop you from doing all you could.
You are salespeople; your briefcases are filled with a product called Hope.
You are explorers, knowing that once you have gone as far as you can see, you will see farther.
You are singers spreading the melody of consideration.
You are lawyers making a case for life.
You are the authors helping others add more pages to their books of memory.
You are comedians dispensing the medicine of laughter.
You are artists who paint pictures of health on the canvas of imagination.
You are magicians creating real miracles that inspire patients and families.
Like King Arthur and Joan of Arc, you are warriors battling against the villains of negativity.
Dorothy would have reached Oz much faster in the company of one nurse, for no one can practice your profession unless they already possess a brain brimming with wisdom, boundless courage, and a heart filled with love.
You are living proof that humanity is created in the image and likeness of God, and the name of that God is Love.
God bless you, and keep up the good work. You are a gift and you are a gift to your patients.

References
Neufeldt, V., & Guralnik, D. (Eds.). (1994). Gift. In Webster’s New World Dictionary (3rd ed.). New York: Prentice Hall.

Word Health Organization. (2002). WHO definition of palliative care. Retrieved September 8, 2003, from http://www.who.int/cancer/palliative/definition/en/
 
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Special Interest Group Newsletter  September 2004
 
   


Caring for Others
A Spiritual Journey

Christina M. Puchalski, MD, OCDS


Caring for people with chronic illness and those who are dying is a wonderful opportunity to make a difference in people’s lives. In this society, the chronically ill and dying often feel undervalued. They have many issues (physical, emotional, social, and spiritual) that need attention. Yet healthcare systems are so stressed with financial issues and overworked staff that patients may not get the attention to their issues that they need. Patients may feel lonely and overwhelmed by large, impersonal healthcare systems. They may face decisions about treatment alone, in a vacuum, not knowing where to turn for help. They may suffer tremendous physical pain or spiritual distress but not know who can help them. The need for compassionate, caring healthcare professionals is great. The opportunity to help exists, but caregivers often believe that they lack the time and skill to help. Yet there is something all of us can do to serve our patients in a more holistic, caring way.

People with serious illness and those who are dying may suffer on many levels. Physical pain and other symptoms can be serious and threaten their lifestyles. Socially, people can feel isolated and disconnected from family, friends, and colleagues. Emotionally, people may grieve and feel despair and intense sadness. Some face serious depression and anxiety. Spiritually, people may question their meaning and purpose in life and their relationships with God and others, and many go through periods of intense darkness and spiritual crisis. Issues of forgiveness, hopelessness, and loneliness may come up as people reflect on their lives.

How can we, as caregivers, help people through this time? Clearly, good pain and symptom management is essential. Providing opportunities for social support, support groups, and therapy may help. Referral to appropriate professionals such as psychiatrists and counselors is critical. But spiritual issues often are not recognized and, therefore, not attended to. Numerous examples exist in clinical cases when, even though physical pain is managed well and patients have adequate social support, people still suffer deeply. So, spiritual issues must be addressed and handled appropriately.

Spiritual care is best done in an interdisciplinary model of care. Thus, all members of the healthcare team are responsible for addressing spiritual issues. Certain members of the team (e.g., chaplain, spiritual director, pastoral counselor) are trained in spiritual counseling or discernment and, therefore, would be the appropriate referrals for more intense spiritual counseling. However, simply referring without also helping patients is not good spiritual care.

The basics of spiritual care are

  • Being fully present to another person in a compassionate way
  • Identifying spiritual issues and communicating about them respectfully
  • Honoring the mystery of life and death and recognizing that not all questions have answers
  • Being attentive to your own spirituality and engaging in a spiritual practice that supports healthcare professionals in their work.
Being present means bringing your whole personhood into relationships with patients. This is the fundamental aspect of spirituality. It is relating from the deep humanity of one person to the other. Some might understand this as relating from your spiritual self. It transcends intellectual attention and physical presence. It is loving, in a broad sense of the word, another human being unconditionally, without expectation or agenda.

Identifying spiritual issues means being able to do a spiritual history. Practically, a spiritual history can be done as part of a social history. It is an inquiry into a patient’s beliefs and values and what gives that person meaning in life. It helps you understand what meaning the illness has for the person, how important the beliefs are to the person, and whether the beliefs impact decision making. It helps identify whether a community, such as church, temple, mosque, family, or friends, support the person in spiritual life. Finally, it helps identify any spiritual issues or distress a patient may have. A healthcare professional then can refer the patient to the appropriate person (e.g., chaplain) or other resource (e.g., meditation classes, yoga, books). The definition of spirituality should be broad and not limited to religion. Spirituality is something that gives deep meaning and purpose to someone’s life and often is the way that people cope with suffering. It can be expressed in religious terms but also in a relationship with God or a force outside of religion, relationships, nature, art, and music. Spirituality is relational, in that the connection healthcare professionals form with their patients is spiritual as defined as compassionate and stemming from service to another. (See www.gwish.org for FICA [F=faith, belief, and meaning; I=importance and influence; C=community; and A=address/action in care] spiritual history tool). Healthcare professionals also must recognize that they need to be respectful of other people’s spiritual beliefs and not impose their own beliefs nor ridicule others’ beliefs.

Honoring the mystery speaks to the acceptance on the part of the healthcare professional, that life and the dying process are filled with uncertainty. To try to move from a “fix-it, have all the answers” medical model to one of accepting and even honoring uncertainty, is challenging yet important. One reason that people may have a hard time talking to others about suffering and dying is that often no answers exist. In fact, part of compassionate care may be simply knowing when to sit in silence as patients grapple with questions of meaning.

Self-care is critical for all healthcare professionals. All of us have our own sources of meaning, purpose, and hope and ways to deal with stress. What are our spiritual beliefs, and do we attend to them, to our spiritual lives? Are our spiritual lives integrated with our work? These are essential questions for us to face and then to work on as we continue to serve others and give of ourselves to our patients. Having a spiritual practice, whether a formal one or one that is personal, is important to sustain us in our work. FICA also can be used as a self-reflection tool for our own lives. Caring for others not only involves being attentive to the spiritual journeys of our patients but also to our own journeys.

Many of us wake up in the morning and hope we can make a difference in someone’s life that day. Caring for our patients affords us many opportunities to do just that. It is not time consuming or difficult. It takes a simple intent to be a compassionate presence, a minister to the ill, and then to simply do our best to help others find some hope, peace, and meaning in the midst of suffering.
 
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Special Interest Group Newsletter  September 2004
 
   


Making the Difference
Guilt and Regret

Johnny Cox, RN, PhD
Orange, CA


The next few minutes might make the difference in how you assist patients and families with ethical decisions about their treatment and care. Of all of the practical pointers I have learned during 25 years as a nurse ethicist, this one tops the list of healing interventions: Distinguish between guilt and regret.

Guilt, as I describe it here, is experienced when healthy people violate their consciences. This feeling arises as an early warning sign about attitudes or behaviors that breach or undermine personal integrity. It creates dissonance in the heart and mind. Guilt that accompanies fault is an essential component of holistic health. Guilt signals that people are out of spiritual alignment when they exploit others, betray confidences, or renege on promises. People who do not experience feelings of guilt when they violate or otherwise abuse themselves or others have a serious health problem. They risk corroding their spiritual centers, where they encounter the ultimate meaning and purpose of their lives. In the extreme, they become people without conscience.

Regret, on the other hand, is the feeling of sadness that accompanies choices that do not turn out as intended or that entail inevitable trade-offs among key values and ethical responsibilities. Regret accompanies our limitations as people. No one has a crystal ball to foresee consequences of decisions. No one is a superperson who can fulfill all of the important responsibilities involved in caring for self and loved ones. Regret is not connected with fault; guilt is not at play here.

But beware: Regret and guilt frequently are confused because the feelings feel a lot alike. A few examples highlight this treacherous confusion.

“I feel so guilty that mom did not die at home the way she wanted. I did the best I could for five months, but I just ran out of energy. If only I had been stronger. I feel so guilty.”

What deep feelings of sadness you have because your mother’s death did not occur as she wanted. It’s too bad it didn’t work out that way. But you cared for her as well as you could until it was no longer possible. Certainly you regret that, but you are not at fault. There is no guilt involved here, no wrongdoing. God does not expect a person to do more than is possible day by day. I hope you would not expect more of yourself than God does. We are human beings with all the limits of time and energy that come with being creatures, not the Creator. Yes, you feel regret, but you are not guilty.

“I feel so guilty that dad took his life. All of the family and the doctor agreed that it was right to tell him the truth about his cancer. You know, that it had spread so much that comfort was the only course of treatment. We knew he would want to know, and everyone was so sensitive and supportive of him. I never dreamed he would kill himself; it was so out of character for him. I feel so guilty.”

What profound feelings of sadness you have because your dad committed suicide after learning about his cancer. But no matter how much you regret what happened after he learned about the cancer, you are not guilty for the choice to tell him the truth. You made that decision because you knew he would want to know, and the family conveyed the truth with sensitive support. No one could have anticipated what he did; in fact, it was out of character for him. You made as good a decision as you could have made; there is no fault. No one is responsible for consequences of good decisions that don’t turn out as intended. Certainly you are feeling deep regret at his suicide, but you are not guilty.

Making the difference between guilt and regret can prevent people from spiraling into neurotic guilt that gnaws on them interminably. The antidote for guilt is forgiveness, but if no fault exists, then being forgiven is impossible. Distinguishing guilt from regret may help some of those we care for reach a healing acceptance of themselves in their human limitations or the peace that comes from a clear conscience, knowing they made as good a decision as they could have made then, even though they regret some consequences now. It probably will help us, too.

Johnny Cox is a moral theologian and RN who serves as the vice president of theology and ethics for the St. Joseph Health System in Orange, CA.
 
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Special Interest Group Newsletter  September 2004
 
   


One Patient Echoes Spiritual Needs of Many

Shirley Otis-Green, MSW, LCSW, ACSW
Senior Research Specialist
City of Hope National Medical Center
Duarte, CA


It still seems like just yesterday. Mrs. A. was a lovely woman in her mid-50s. She had widely metastatic breast cancer and a growing recognition that her time was limited. She and I had met only superficially in the past when I offered her information about supportive services available, each of which she briskly dismissed. Today clearly was different. Mrs. A entered my office distraught and immediately began crying—wailing, really. Loud, sustained cries from deep within wracked Mrs. A’s now frail frame. She began to sway back and forth, and I tried to remember where our smelling salts were, as she seemed quite likely to pass out. I heard muffled calls from my coworkers as they sought to determine whether I was engaging in vivisection with a patient or was in need of security. I found myself simultaneously trying to calm their concerns and soothe Mrs. A, who continued to weep and rock. When she finally was able to speak again, she began to tell me what was wrong. She said that she had just come from her doctor’s appointment and realized that there was no longer any realistic possibility of a cure. In a panic, she had come straight to my office. Between sobs, she began to talk.

“I know what my husband’s favorite meals are, my son’s favorite music, my daughter’s favorite colors. I’ve lived my entire life to please my parents, my family, my teachers, my friends, and I don’t know who I am. I wear red because others tell me it looks good on me, but I don’t think I even like red. If I were to be offered a last meal, I don’t know what I’d choose. I’m a fraud! I can’t die yet because I’ve yet to have really lived. I don’t know who I am, and now it’s too late to find out!”

Her words have informed much of what I have tried to do ever since. Others have sat in that chair, but few have been as articulate about the depth of their spiritual suffering. The lessons that she taught have been a constant reminder to seek to have an authentic life. Her words echo for me the importance of minimizing regrets. Mrs. A’s eventual death was as tormented as she had imagined it would be and haunts me still. Her suffering was well beyond the reach of mere morphine and taught me that effective palliative care requires that practitioners be skillful in assisting patients in the process of meaning-making and legacy-building at the end of life.

***

I hadn’t intended to focus on end-of-life care. It just happened. As a clinical social worker, I had made a conscious commitment to advocate for the most vulnerable. At first, I worked with foster children, then with the sexually abused. Later, I found my way into oncology, hospice, pain management, and eventually palliative care. At each step, I discovered that although the clients who I served were different, their issues were strikingly similar. I found that all were struggling with transition and loss. My job in each was to offer anticipatory guidance, education, support, and a companioning presence and to bear witness to another’s journey of discovery and growth. It was only retrospectively that I recognized this work as spiritual care and that my responsibility was (is) always to nurture the spirit.

Soul work invites introspection. I often say that a diagnosis of cancer is an invitation to consider the possibility of a person’s own mortality. Now I recognize that to work with those with life-threatening illness also invites an attentive caregiver to consider the same. In this role, we have the privilege to see dying done by experts and to benefit from this vicarious learning opportunity. What I have learned is that regrets increase our suffering and that dying comes packaged with enough suffering without adding any more. I have tried to use that knowledge in guiding my decision making ever since. I have discovered that despite the challenges inherent in identifying yourself as a change agent, the rewards are greater still. I sleep better at night, knowing that I have tried to take a stand and make a difference. Sitting at the bedside of a dying person reminds me that our work matters. Listening to those in our bereavement support group recalling the events of long-ago deaths reminds me how lasting this work is for those whose lives we touch.

I keep a well-worn copy of Mosby’s Medical and Nursing Dictionary by my desk at all times. In it, I note that to palliate is “to soothe or relieve.” That seems to make it a synonym for spiritual care as well. The goal in either case is to assess a person in discomfort to better understand the source of his or her suffering. In both spiritual care and palliative care, we realize that we must individualize interventions if they are to be most meaningful. In both, we strive to integrate appreciation for the cultural nuances that influence us. Both require a commitment to be present with another to really hear and understand his or her personal narrative. Neither spiritual care nor palliative care readily lends itself to absolutes. Rather, both invite us to increase our tolerance of ambiguity. As a member of an interdisciplinary pain service, I have learned to be a pragmatist. The various equianalgesic dosing formulas serve as a metaphor for the many spiritual practices that offer comfort to our diverse community of patients served. Different strategies seem to work for different folks, and our responsibility is to be skillful and creative enough to have many choices available to soothe or relieve those we serve.
 
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Special Interest Group Newsletter  September 2004
 
   


Update on the Spiritual Care Toolkit



A proposal for the Spiritual Care Toolkit was submitted and received favorably, and now we are waiting for final approval. In the meantime, we would like to enlist people who would like to learn more about the project and become involved. We need people to assist in many ways; tasks that require relatively small amounts of time are available. Please send any questions along with your name and e-mail (or address) to Marilyn Tuls Halstead, RN, PhD, AOCN®, at mhalstead@towson.edu. More information will be coming as soon as possible.

Spiritual Care Toolkit: A Case Study Approach

Outline of Content
  1. Introduction to spiritual care in nursing
    1. Mandate to provide spiritual care
      1. Joint Commission on Accreditation of Healthcare Organizations
      2. ONS Standards of Care
    2. Oncology nursing roles and responsibilities related to spiritual care
      1. Evidence-based nursing care
      2. Collaboration with spiritual care professionals
    3. Interaction of culture and spirituality among people with cancer
  2. Issues of spirituality for people with cancer
    1. Connecting
    2. Meaning and purpose in life
    3. Faith
    4. Forgiveness
    5. Hope
    6. Suffering
    7. End of life
  3. Assessment and diagnosis of spiritual health
  4. Spiritual care interventions
    1. Presence
    2. Meditation
    3. Prayer
    4. Use of the arts (e.g., music, art, dance)
    5. Storytelling
    6. Journaling
    7. Bibliotherapy
    8. Humor
  5. The role of ritual in spirituality: major faith traditions and spiritual care in oncology nursing
  6. Spiritual self-care for oncology nurses
  7. Resources
 
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Special Interest Group Newsletter  September 2004
 
   


SIG Rolls Out the Red Carpet to New Members

The following nurses joined the Spiritual Care SIG in April 2004.
Sandra Barrett, RN, OCN®, Georgia
Mary Boyd, RN, BSN, California
Karen Davidson, RN, OCN®, Georgia
Margaret Doyle, RN, BSN, New Jersey
Sandra Florez, RN, Arizona
Mary Heckel, OCN®, Maryland
Cynthia King, PhD, NP, MSN, RN, North Carolina
Vickie Kirkwood, RN, Texas
Connie Kreuz, RN, Montana
Lisa Randolph, RN, Texas
Teresa Ritter, RN, OCN®, Florida
Jennifer Sellar, Texas
Mary Stiers, RN, Ohio
Yuki Tasaka, Colorado

The following members joined in May 2004.
Julianne Buenting, RNC, DNS, Illinois
Trina Emerson, RN, Virginia
Shaylon Grant, RN, Tennessee
Margaret Griffiths, RN, MSN, AOCN®, New Jersey
Kimberly Henry, RN, BSN, Pennsylvania
Benetta Kohn, RN, OCN®, Maryland
Margaret Seger, RN, BSN, OCN®, Connecticut
Gayle Terry, RN, BSN, OCN®
Joan Thomas, RN, BSN, Pennsylvania

These nurses signed up in June 2004.
Janine Blakeslee, RN, Michigan
Sharon Carelli, RN, BSN, MPS, Nevada
Nancy Dann, RN, BCC, Massachusetts
Dawn Gubanc, RN, MSN, Ohio
Debra Lundquist, RN, MSN, CS, Massachusetts
Linda Sue Meacham, RN, OCN®, Louisiana
Karen Pike, RN, OCN®, California
Susan Ross, IN
Celeste Schiller, RN, BSN, OCN®, Pennsylvania
Sheila Smith, RN, OCN®, Ohio
Ila Sowins, RN, OCN®, Arizona
Janice Zeller, RN, PhD, FAAN, Illinois
 
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Special Interest Group Newsletter  September 2004
 
   


Click on Helpful Palliative Care Resources


Check out these resources for issues related to palliative care.

Institute of Medicine at the National Academy Press
www.iom.edu or www.nap.edu

National Comprehensive Cancer Network
www.nccn.org 

Oncology Nursing Society
www.ons.org

American Society of Clinical Oncology
www.asco.org

American Society of Health System Pharmacists
www.ashp.org

American Cancer Society
www.cancer.org

National Consensus Project
www.nationalconsensusproject.org

City of Hope Pain/Palliative Care Resource Center
http://prc.coh.org

Growth House
www.growthhouse.org

Hospice and Palliative Nurses Association
www.hpna.org

National Hospice and Palliative Care Organization
www.nhpco.org

Palliative Care: One Vision, One Voice
www.palliativecarenursing.net
 
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Special Interest Group Newsletter  September 2004
 
   


Advanced Certification Will Become Role Specific


Beginning in January 2005, the Oncology Nursing Certification Corporation (ONCC) will administer role-specific advanced practice certification examinations for oncology nurse practitioners (NPs) and oncology clinical nurse specialists (CNSs). The AOCN® examination, which first was administered in 1995, will be offered for the last time via computer-based testing October 18–30, 2004. Current AOCN®s may continue to renew AOCN® certification through the Oncology Nursing Certification Points Renewal Option for as long as they desire to keep the AOCN® credential. Testing no longer will be an option for the renewal of AOCN® certification.

The decision to develop role-specific NP and CNS examinations was data driven, based on the results of the role delineation study of advanced practice oncology nurses, conducted by ONCC and the Chauncey Group International (a subsidiary of Educational Testing Services) in 2003. Role delineation studies validate that the content of a certification examination is representative of the actual practice of the profession on which it is based. Accreditation standards for certifying organizations indicate that role delineation studies must be conducted on a regular basis. ONCC is accredited by the National Commission for Certifying Agencies and the American Board of Nursing Specialties. ONCC policy requires that role delineation studies be conducted every five years for each certification. In addition to the 2003 study, ONCC conducted advanced practice role delineation studies in 1994 and 1998. Because the previous studies did not reveal differences in the practice of oncology NPs and oncology CNSs, one examination was valid to test both roles in oncology. However, the most recent study revealed that although oncology CNSs and oncology NPs continue to share a common knowledge base, discernable differences now exist in their work responsibilities. The differences are significant enough to warrant the development of role-specific examinations.

Because oncology NPs and oncology CNSs share a common knowledge base, the new test blueprints (content outlines) for the oncology CNS examination and the oncology NP examination are very similar. The major differences between the two blueprints are in the weighting of the content areas and that the roles of the CNS (other than clinical practice) are not represented on the oncology NP examination. The test blueprints can be found on the ONCC Web site at www.oncc.org.

The decisions regarding eligibility criteria for the new advanced examinations were made carefully in an effort to ensure that they are rigorous enough to be meaningful yet attainable by most advanced practice nurses specializing in oncology. The eligibility criteria for the Advanced Oncology Certified Nurse Practitioner (AOCNP) certification examination include

  • Current, active, unrestricted RN license at the time of application and examination
  • Master’s or higher degree in nursing from an accredited institution
  • Successful completion of an accredited NP program
  • A minimum of 500 hours of supervised clinical practice as an oncology NP. These hours may be obtained in the NP program or after graduation from the program.
The eligibility criteria for the Advanced Oncology Certified Clinical Nurse Specialist (AOCNS) examination include
  • Current, active, unrestricted RN license at the time of application and examination
  • Master’s or higher degree in nursing from an accredited institution
  • Minimum of 500 hours of supervised practice in an advanced practice role in oncology nursing. These hours may be obtained in the graduate educational program or after graduation from the program. The required practice hours must be verified by a faculty member, preceptor, physician, or supervisor.
Because the eligibility criteria and content of the new examinations will differ significantly from the current AOCN® examination, those who hold AOCN® certification cannot be “grandfathered.” The standards of certification accrediting agencies indicate that granting a credential in the absence of evaluating the knowledge and skill of an individual is not acceptable. Part of the purpose of certification is to inform the public of the particular specialized experience and knowledge of individuals who hold the credential. Certifying organizations are responsible for ensuring that certified individuals have the experience required and have demonstrated the knowledge through objective assessment.

ONCC will, however, offer a $100 discount to all eligible nurses who take one of the new examinations during the first two computer-based administrations on January 17–29 or April 18–10, 2005. The respective deadlines to register for these administrations are October 13, 2004, and January 15, 2005.

Because many state boards of nursing require advanced practice nursing certification for the regulation of advanced practice nurses, ONCC will contact all state boards and inform them of the changes to advanced practice nursing certification in oncology. Several state boards previously did not recognize the AOCN® examination because it was not role specific and now may be willing to grant recognition for the new examinations. All advanced practice nurses must understand fully the requirements of their individual state boards of nursing and comply with those requirements. ONCC maintains a list of state boards that recognize the AOCN® certification on the ONCC Web site and will develop a similar list for the new credentials. ONCC also will seek recognition of the new credentials by the Centers for Medicare and Medicaid Services (CMS). Recognition of the AOCN® credential was granted by CMS.

Please contact ONCC at oncc@ons.org or 1-877-769-6622 with specific questions about the new certifications.
 
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Special Interest Group Newsletter  September 2004
 
   


What’s New in the Spiritual Care Community

New Center to Fight for Human Dignity and Ethics in Nursing

The School of Nursing at Spaulding University in Louisville, KY, announces the opening of the Center for the Study of Human Dignity, Ethics and Caring in Nursing. The center’s mission is to affirm, protect, and defend the dignity of the human person through education, consultation, research, service, and dissemination of findings.

Unique among schools of nursing in the United States, the center will offer a paradigm of learning opportunities and services in partnership with healthcare facilities, educational institutions, professional organizations, and community groups.

The center sets the School of Nursing and its educational endeavors on a distinctive trajectory to respond to current and emerging clinical ethical issues among patients, families, nurses, other healthcare professionals, communities, societies, and how we ought to care for our most vulnerable citizens.

The center will celebrate its inaugural event from 8:30 am to noon on Friday, September 24, 2004, in the auditorium of Baptist Hospital East. Carol Taylor, CFSN, PhD, MSN, RN, director of the Center for Clinical Bioethics at Georgetown University Medical Center in Washington, DC, will address “Morality Internal to the Practice of Nursing.” The event is free and open to the public, but registration is required and limited to 240 participants. Call Bonnie Caughron at 502-585-7125.

Scope and Standards of Parish Nursing Practice Will Be Revised

The Scope and Standards of Parish Nursing Practice, first published in 1998, is undergoing revision. The Health Ministries Association has been instrumental in supporting the volunteer members of the Working Group completing that six-month work effort. The Working Group has posted the draft Faith Community Nursing: Scope and Standards of Practice document for public review and comment at www.hmassoc.org/pdf/scopeandstandards.pdf.

Instructions for submission of public comments are included on page 3 of the document. The deadline for submission of comments is September 10, 2004.
 
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Special Interest Group Newsletter  September 2004
 
   

Membership Information


SIG Membership Benefits

  • Network with colleagues in an identified subspecialty area around the country.
  • Contribute articles for your SIG’s newsletter.
  • Participate in discussions with other SIG members.
  • Contribute to the future path of the SIG.
  • Share your expertise.
  • Support and/or mentor a colleague.
  • Receive information about the latest advancements in treatments, clinical trials, etc. Participate in ONS leadership by running for SIG coordinator-elect or join SIG work groups. Acquire information with a click of a mouse: http://sig.ons.wego.net
    • Educational opportunities for your subspecialty
    • Education material on practice
    • Calls to action
    • News impacting or affecting your specific SIG
    • Newsletters
    • Communiqués
    • Meeting minutes
Join a Virtual Community

A great way to stay connected to your SIG is to join its Virtual Community. It’s easy to do so. All you will need to do is
  • Log on to the ONS Web site (www.ons.org).
  • Select “Membership” from the tabs above.
  • Then, click on “ONS Chapters and Special Interest Groups.”
  • Scroll down to “Visit the ONS Special Interest Groups (SIG) Virtual Community” and click.
  • Now, select “Find a SIG.”
  • Locate and click on the name of your SIG from the list of all ONS SIGs displayed.
  • Once the front page of your SIG’s Virtual Community appears on screen, select “New User” from the top left. (This allows you to create log-in credentials.)
  • Type in required information into the text fields as prompted.
  • Click “Join Group” (at the bottom right of the text fields) when done.


    • Special Notices
    • If you already have log-in credentials generated from the ONS Web site, use this information instead of attempting to generate new information.
    • If you created log-in credentials for the ONS Web site and wish to have different log-in information, you will not be able to use the same e-mail address to generate your new credentials. Instead, use an alternate e-mail address.
Subscribing to Your SIG’s Virtual Community Discussion Forum

All members are encouraged to participate in their SIG’s discussion forum. This area affords the opportunity for exchange of information between members and nonmembers on topics specific to all oncology subspecialties. Once you have your log in credentials, you are ready to subscribe to your SIG’s Virtual Community discussion forum. To do so
  • Select “Log In,” located next to “New User” and enter your information.
  • Next, click on the “Discussion” tab on the top right of the title bar.
  • Now, select “Featured Discussion” from the left drop-down menu.
  • Locate and select “Subscribe to Discussion” inside the “Featured Discussion” section.
  • Go to “Subscription Options” and select “Options.”
  • When you have selected and entered all required criteria, you will receive a confirmation message.
  • Click “Finish.”
  • You are now ready to begin participating in your SIG’s discussion forum.
To Participate in Your SIG’s Virtual Community Discussion Forum
  • First, log in. (This allows others to identify you and enables you to receive notification (via e-mail) each time a response or new topic is posted.
  • Click on “Discussion” from the top title bar.
  • Select “Featured Discussion” from the left drop-down menu.
  • Click on any posted topic to view contents and post responses.
Signing Up To Receive Your SIG’s Virtual Community Announcements

As an added feature, members also are able to register to receive their SIG’s announcements by e-mail!
  • From your SIG’s Virtual Community page, locate the “Sign Up Here to Receive Your SIG’s Announcements” section. This appears above the posted announcements section.
  • Select the “Click Here” feature, which will take you to a link to subscribe.
  • Once the “For Announcement Subscription Only” page appears on screen, select how you wish to receive your announcements:
    • As individual e-mails each time a new announcement is posted
    • One e-mail per day comprised of all new daily announcements posted
    • Opt-out, indicating that you will frequently browse your SIG’s Virtual Community page for new postings
  • Enter your e-mail address.
  • Click on "Next Page."
  • Because you have already joined your SIG’s Virtual Community, you will receive a security prompt with your registered user name already listed. Enter your password at this prompt and click “Finish.”
  • This will bring up a listing of your SIG’s posted announcements. Click on “My SIG’s Page” to view all postings in their entirety or to conclude the registration process and begin browsing.
 
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Special Interest Group Newsletter  September 2004
 
   


Spiritual Care SIG Officers

Coordinator (2004–2006)
Marilyn Tuls Halstead, RN, PhD, AOCN®
905 Magnolia Ct.
Westminster, MD 21157-6260
410-751-6285 (H)
410-704-5351 (O)
410-704-6333 (fax)
mhalstead@towson.edu


Ex-Officio (2004–2005)
Judy Schreiber, RN, MSN
493 Amberley Dr.
Lexington, KY 40515-4775
859-245-5665 (H)
502-550-0889 (O)
859-219-0073 (fax)
jschreib@amgen.com

 

Editor
Tami Borneman, RN, MSN, CNS
15845 Buena Vista Dr.
Derwood, MD 20855-2659
301-721-9370 (H)
202-444-3536 (O)
301-721-9375 (fax)
tbornema@earthlink.net

ONS Publishing Division Staff
Keightley Amen, BA
Copy Editor
412-859-6258
Kamen@ons.org

 

Know someone who would like to receive a print copy of this newsletter?
To print a copy of this newsletter from your home or office computer, click here or on the printer icon located on the SIG Newsletter front page. Print copies of each online SIG newsletter also are available through the ONS National Office. To have a copy mailed to you or another SIG member, contact Membership/Leadership Administrative Assistant Carol DeMarco at cdemarco@ons.org or 866-257-4ONS, ext. 6230.

ONS Membership/Leadership Team Contact Information
Angie Stengel, Director of Membership/Leadership
astengel@ons.org
412-859-6244

Diedrea White, Manager of Member Relations and Diversity Initiatives
dwhite@ons.org
412-859-6256

Carol DeMarco, Membership/Leadership Administrative Assistant
cdemarco@ons.org
412-859-6230

To view past newsletters, click here.

The Oncology Nursing Society (ONS) does not assume responsibility for the opinions expressed and information provided by authors or by Special Interest Groups (SIGs). Acceptance of advertising or corporate support does not indicate or imply endorsement of the company or its products by ONS or the SIG. Web sites listed in the SIG newsletters are provided for information only. Hosts are responsible for their own content and availability.

Oncology Nursing Society
125 Enterprise Dr.
Pittsburgh, PA 15275-1214
866-257-4ONS
412-859-6100
www.ons.org

 
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