Teaching Clinicians to Care for Themselves

Gwish
Left to right: Christina Puchalski, GWish director; GW President Steven Knapp; Rep. Tim Ryan; Howard Koh, assistant secretary for health; and Vincent Chiappinelli, GW interim associate vice president for health affairs.
Fifth annual GWish Spirituality and Health Summer Institute brings psychosocial and spiritual well-being into focus.
July 22, 2013

By Kristin Hubing

Around-the-clock media coverage and heated political disputes have made the debate about U.S. health care reform difficult to overlook. However, there is a quieter revolution occurring in the field simultaneously — one that stresses the importance of whole-person care that focuses on psychosocial and spiritual, as well as physical, well-being.

The 52 participants who gathered for the George Washington University Institute for Spirituality and Health’s (GWish) fifth  annual Spirituality and Health Summer Institute July 10–13 were testament to the progress of this quiet revolution promoting spirituality in health care as an essential element of compassionate care. Participants included physicians, nurses, educators, chaplains and social workers from across the country and around the world, all of whom share a passion for transforming health care so that patients, families and clinicians can find greater meaning, hope and a sense of healing--even in the face of serious illness and stress.

Founded in 2001, GWish works toward a more compassionate system of health care by restoring the heart and humanity of medicine through research, education and policy work focused on bringing increased attention to the spiritual needs of patients, families and health care professionals. The groundbreaking effort GWish has undertaken for more than a decade, developing innovative new teaching methods in medical education and establishing national and international standards in interprofessional spiritual care, has cultivated a wealth of enthusiasm throughout the health care continuum.

As the first university-chartered institute for spirituality and health in the United States, GWish is committed to education and clinical issues related to spirituality and health. The momentum the summer institute has built demonstrates a genuine interest in ideas that break from convention and a recognition of the power that this movement holds for the future direction of health care.

“This year’s conference has validated the work of so many colleagues who strive for the best care patients can receive where patients’ values, beliefs and what gives them meaning is honored and integrated into their care plans,” said Christina Puchalski, M.D. ’94, founder and director of GWish, professor of medicine at GW’s School of Medicine and Health Sciences (SMHS), and pioneer in the realm of spirituality and health. In addition to patient care, Dr. Puchalski noted that compassion begins with clinicians showing compassion for themselves. “This fifth summer institute is teaching clinicians how to provide compassionate care while also taking care of themselves.”

Dr. Puchalski noted the emerging emphasis on self-care, pointing to Cynda Rushton, the Anne and George Bunting Professor of Clinical Ethics at the Johns Hopkins University Berman Institute of Bioethics, who presented a half-day workshop on moral distress and the role of compassion in clinician self-care. “Spirituality, an integral part of every person, is about meaning and connectedness,” said Dr. Puchalski. “Leaders are speaking with earnest conviction about the importance of spirituality as the core of whole-person care.”

Learning objectives of the four-day institute included recognizing the role of spirituality as an essential component of patient-centered care, developing an understanding of the evidence base for integrating spirituality into patient care, and acknowledging the role of spirituality in how patients define health, wellness and quality of life. Workshop presenters engaged participants in treatment plans, such as meaning-oriented therapy developed by William Breitbart, acting chair of psychiatry and behavioral sciences at Memorial Sloan-Kettering Cancer Center, and workshops on spiritual practices such as gratitude and mindfulness offered by Tara Healey, program director for mindfulness-based learning at Harvard Pilgrim Health Care. Educators led the participants in GWish-Templeton Reflection Rounds, funded by the John Templeton Foundation as an innovative educational strategy to teach competencies in spirituality and health education.

"This is a field in which our university has had the privilege of being a leader thanks to all of you who have come each summer to our summer institute," said President Steven Knapp in welcoming remarks.

The institute’s opening plenary featured two keynote speakers: Harvey Fineberg, president of the Institute of Medicine, and Howard Koh, assistant secretary for health for the U.S. Department of Health and Human Services. Dr. Fineberg reflected on the relevance of spirituality for both patient and caregiver. “Not only are the ideals of scientifically grounded health care and spiritually centered care compatible, but they are also integrally interdependent,” he said.

Dr. Koh, who followed Dr. Fineberg, thanked GWish and the participants for being pioneers in what he called an exciting and innovative effort. “Much like public health overall, we don’t know where this journey will lead or what the conclusions will be, but we have decided it’s important to take a risk and come together to help each other find better answers,” Dr. Koh said.

The institute featured a combination of panel speakers, such as Benjamin Blatt, professor of medicine at SMHS, as well as small group discussions and workshops where participants completed biopsychosocial-spiritual model assessments for standardized patient cases and created plans to enhance the patients’ physical, emotional, social and spiritual well-being.

“The goal is developing new modalities of care that address the complete person,” said Dr. Puchalski. “Spirituality and health is about developing a standard of care, those treatment plans that are whole-person centered.”

During a “State of the Science in Spirituality and Health” session, George Fitchett, professor and director of research in the Department of Religion, Health, and Human Values at Rush University, provided an overview of current research on the role of religion and spirituality in patient health outcomes. “A substantial body of research on these topics has developed over the last 15 years,” said Dr. Fitchett, who outlined advances that have been made in understanding the effects of spirituality for patients with serious illness. “Studies show patients have spiritual needs that range from overcoming fears to finding peace, to hope and meaning, to spiritual resources that may help them. They want their clinicians to address their spirituality and integrate that into their care.” Dr. Fitchett also noted the need for better studies, including studies in different cultures, as well as diagnostic groups, in order to better understand spiritual well-being, spiritual distress and spiritual practices in patients’ health care.

Rep. Tim Ryan, D-Ohio, author of “A Mindful Nation: How a Simple Practice Can Help us Reduce Stress, Improve Performance, and Recapture the American Spirit,” praised GWish for its efforts to draw connections between personal practices and health outcomes. Rep. Ryan noted that a variety of personal practices are leading to a revolution in the field of health care. “As Joseph Campbell, the great comparative mythologist said, revolution doesn’t have to do with smashing something. It has to do with bringing forth something. And that’s what we’re doing today.”