The Salvation Army NSW Property Trust
Finding meaning through spirituality - not just religion
The Salvation Army NSW Property Trust
Pacific Lodge Aged Care Plus Centre, Dee Why, NSW
Residential - Metropolitan, 30-79 beds
Health and wellbeing, Communication and engagement, Diversity
About the program
Good care provision requires aged care workers to understand not only physical aspects of ageing, but also residents’ psychological, social, emotional and spiritual needs based on individual preference, despite their cognitive status.
Dementia and mental illness are significant factors for older persons as they journey the ageing continuum. Significant impacts of the ageing journey on wellbeing are primarily related to an inward focus on self and lack of ability to reflect on the reality of the current circumstance. The understanding of spirituality and its positive effects on wellness is underestimated.
This program is a spiritual assessment and care planning approach for residents who are socially disadvantaged, often rejected by society as a result of mental illness and complex care needs from a lack of awareness and insight due to chronic alcoholism. This model was derived from an identified need that all people are inherently spiritual in nature. This resulted in a paradigm shift in care planning and assessment from a medical model to the notion of caring for one’s spirit. This has resulted in a deeper connectivity and relationship with our residents at the home.
What we did
In considering the methodology and approach to assessing spirituality, consideration was given to the association with religion and an understanding of its impact on spirituality. Spirituality is the personal quest for understanding answers to ultimate questions about life, meaning, relationships and the formation of community.
To develop the tools and guidelines, methodology and evidence based design was based upon contemporary research for ageing and spirituality, specifically focussed for the target resident cohort. The design ensured a relational approach was adopted which supports the resident to reflect on meaning for them as a person.
Design included specific focus on empowerment and enablement. By nurturing and exploring the spiritual dimension of the resident, this identified not only strategies for spiritual expression and fulfilment, but also provided key information to support activities of daily living. The collaborative nature of the assessment technique with the Chaplain and greater care team is a vital element in the success of the new care planning approach.
This approach ensures the individual needs and the diversity of spirituality is encapsulated and forms the basis of relationships with the resident, underpinning all interactions and care interventions in place. Objectives were based upon a continuous improvement approach in achieving a better outcome for resident contentment.
Measurable outcomes were:
- Atmosphere of trust and peace
- Supported residents and family
- Reduction in fears and anxiety about suffering and death
- Increased coping skills
- Dignity and sense of personhood
- Interpersonal connections
- Sense of meaning and purpose for all involved
The spiritual assessment process includes:
- Imagery cards designed to evoke emotional awareness (Ups and Downs Cards)
- Conversational tools
- Symbols of spirituality where residents can touch objects and identify how their symbolism impacts their spirituality
- Religious practices
- Life history and tools to assist in capturing individual story
Planning and implementation involved
- Model design informed by data collection, research, workshops, training, and consultation with staff, residents and families
- Review of resources available
- Development and design of spiritual assessments in collaboration with Charles Sturt University to ensure assessment validity
- Development and design of training resources accessible for all staff
- Identification of risk, and mitigation strategies
Ongoing monitoring and evaluation is achieved through the review of individual spiritual care plans for residents and updating spiritual assessments in alignment with assessment processes within the home.
The key innovation is that in meeting and understanding the spiritual needs of our residents, this ultimately meets all their needs. The approach is the opposite view of the medical model and is an approach not often seen within person centred frameworks currently observed in the aged care industry.
Why we did it
The target group for this home experience great difficulty gaining access to residential aged care services. The majority of residents have a diagnosed mental illness, history of institutionalisation or homelessness, substance abuse, and previous failed residential placements. There is a general reluctance to admit this cohort to mainstream aged care for these reasons.
A typical medical management approach to care delivery is not an effective approach for this resident target group. In fact, we identified a decreased level of satisfaction as a result of this model and increased exacerbations of adverse behaviours and episodes of absconding as a result of this focus. An identified issue for residents within this home was a sense of incompleteness and realisation that some things will be left undone.
Residents expressed there were aspects of life left unresolved and this impacted their wellness and consequently their physical dependence. Sadly, some residents only saw darkness and struggled to work through their own sense of spirituality.
In response to these observations, feedback and the identified increase in expressive behaviours, consumer dissatisfaction and increased resident turnover, a pilot was established to undertake spiritual assessment and care planning for residents and use this as the basis for care provision.
This approach has demonstrated spiritual well-being can result in empowerment, enablement and contentment for persons whose life experience has been marred by hardship, tragedy and often stereotypical ideations from people further reducing the person’s ability to be oneself.
Who worked with us
The project has resulted in consultative relationships being forged between the organisation and external partners as well as collaboration with other international internal arms of the organisation. Feedback from residents and staff has been positive, providing evidence that supports the importance of spiritual awareness from a care context.
As a result of the implementation of this program, the following partnerships have been formulated:
- Links with the Charles Sturt University were made in order to develop specific assessment tools which were research validated and trialed under a research design. This was completed as part of a Master’s Thesis and resulted in collaboration with numerous external experts in regards to spirituality and ageing from America, the United Kingdom and Canada. The extensive external consultation process allowed for a truly diverse and meaningful tool which was confirmed by consumers and their representatives during the trial period
- International collaborations – As part of the research design several contacts were made with international partners in order to review the efficacy of the tool from a transferability perspective
- International conference presentations – the continuous improvement approach of the tool and its efficacy have been reported on through the 5th and 6th International Conference on Spirituality and Ageing which allowed for the process, design and tool to be reviewed by international research scholars within the field of spirituality and ageing
What we learned
Ongoing evaluation of the tool and care plans efficacy is measured through the following quality governance processes:
- Review of clinical indicators
- Monitoring of audit results
- Resident and representative satisfaction surveys
- Consumer feedback
- Clinical assessments
Our evaluative processes for this program have been achieved through:
- Model structure
- - The implementation plan was comprehensive and had full home and staff participation. Stakeholder engagement was ascertained prior to the roll-out and continues to be refined based on the results and feedback obtained
- Model structure
- - policies and guidelines are embedded within the organisation’s culture, governance processes and reporting structures to ensure sustainable compliance to required practice and expected outcomes for residents
- Distribution of program and evaluation
- data – data about the project outcomes is reviewed regularly by a centralised education team. Reporting of spiritual care plan completion has now become an organisational key performance indicator for all residential homes
- Regular evaluation of quality and clinical governance data
- Continued professional development
- of all relevant stakeholders is essential in ensuring ongoing efficacy due to the general misunderstandings of spirituality amongst health care professionals
The outcomes and benefits for our residents have been very positive. This is based on resident feedback from the home where the spiritual care plan and assessment tools are fully integrated into the model of care:
"It helps you carry on with life when you feel like giving up"
"It raises the spirit, thinking back, relating what has been important"
"Finally there is someone who cares about me, my history and what is important to me, no-one has ever asked me why I am how I am and I feel cared for and loved, I finally have a voice."
"I never realised what a difference it would make to me and those who care for me"
"Someone other than my family is interested in who I am, that’s what makes this place different"
"Sharing in this way helps alleviate intense loneliness in care"
The results support the following outcomes:
- A reduction in discharges due to improved well-being of the resident cohort
- Improved satisfaction
- Increased emotional awareness. Through the review of care plans it has been identified the emotional expression and experience associated with increased spiritual practice assists with normalising the person’s lived experience. Many of our residents at the home are unable to have insight into the situation or circumstance they are in. Older Australians in the target group are unable to identify or be aware of the links between their response to the environment or social context they live in and how to actively engage in spiritual expression. The care plan allows for interventions to assist them in this process resulting in emotional awareness.
- Emotional connectivity – When we focus on the individualised spiritual expression of the resident, this allows the care giver to identify specific interventions to support well-being and focus on an empowerment and enablement care focus rather than a dependent model.
- Contentment – The interventions implemented in the care plan, result in achieving contentment for the individual and this in turn increases their wellness experience. The model gives the person a supportive framework to ultimately find meaning in life.
Providers interested in this innovation are able to implement this model effectively and this tool and care planning approach has now been implemented in all residential homes within the organisation based on the results of the trial and ongoing continuous improvement measures.
The key learnings for ongoing continuous improvement are as follows:
- An integrated multi-disciplinary approach
- An intensive training strategy
- Reinforcing spirituality is not religion; however religion can be an expression of spirituality
- Reinforcing the strategic decision and reasons behind the model of care
More information on this program:
Sharon Callister, firstname.lastname@example.org, or phone 1300 111 227