Director's Note, Upcoming Events, Community Events, Interview with Realities organizer Micki Jackson, and presenter Rebecca Culter, FCN, and Devotional.
Dear health ministries community,
Happy new year to you and yours! As we enter 2020, I hope you’ll support HMN’s new year’s resolution to expand the reach of health ministries in our community. The more I learn about the power of faith community nurses and health ministers, the more I know how important it is for more folks to have this support in their faith community.
As part of this, we are inviting faith community leaders to a breakfast on Wednesday, January 22. Please help us spread the word to bring together a diverse array of faith communities! Thank you for partnering with us on this important work.
I hope you’ll read the full newsletter including an interview Micki and Rebecca, who generously give their time to help folks plan for medical care decisions. Their motivations and plans for the future are truly inspiring.
Thank you to Rev. Cindy Bauleke for sharing inspiration as well in the form of this month’s beautiful devotion.
Warmly,
Amelia Vader Executive Director amelia@healthministriesnetwork.net
Upcoming Events
January Meeting
Friday, Jan 17, 11:00 AM – 1:00 PM
First Congregational Church, 2401 Cornwall Ave, Bellingham
Please join us for a for our January meeting, where FCNs and HMs network, lunch, and learn. Program TBA. This meeting is free and all are welcome, especially those interested in health ministry! A light lunch will be provided.
Faith Community Leader Breakfast
Wednesday, Jan 22, 2020, 8:00 AM – 10:00 AM
First Congregational Church, 2401 Cornwall Ave, Bellingham
Join us to learn how faith community nursing can support you and your congregation. Whether you have an established health ministry or are interested in learning more, we hope you'll join us! Open to clergy, pastors, rabbi, and anyone interested in health ministry.
Foundations Course
April 3 - May 31
Online and in-person at First Congregational Church, 2401 Cornwall Ave, Bellingham
Prepares state licensed RNs for faith community nurse ministry and other caring individuals for health minister service in their respective congregation or faith community.
Community Events
In an effort to connect our volunteers with relevant resources, we publish community events in our monthly newsletter and on our website. Email sampson@healthministriesnetwork.net to add your own.
Webinar: American Society on Aging: Innovative Approaches to Reach Underserved Populations Living with Dementia
Wednesday, January 8th, 10 AM PT
This webinar will provide examples of community-based programs that strive to meet the needs of specific underserved groups, including the Hispanic/Latino population and persons with intellectual and developmental disabilities and dementia.
Spotlight
Micki Jackson (right)
Realities Organizer, Community Advocate for Outpatient Palliative Care
Rebecca Cutler (left)
Realities Presenter, FCN for Unity Spiritual Center
What is “Realities of Advanced Medical Interventions” (Realities) and why is it important?
Rebecca: "Realities of Advanced Medical Interventions" (Realities) is a talk for the public to learn how you will be treated, for example, if you have a cardiac arrest. It covers what advanced medical interventions could be used if you make it to the hospital.
I also talk about the statistics of the outcomes: How many people survive and what their level of functioning is. A lot of times we hear the numbers and think, ‘oh, that’s pretty good’ (although they're actually not that great), but the thing that's not always mentioned is quality of life. People need to know they may survive an advanced medical intervention but may not have the same quality of life as they did before. There's a high number, like over 50 percent, of people who have cognitive functioning issues after these treatments.
It's really important that people have informed consent and you can't have informed consent if you don't know what's real and what's not. We have so many television shows where somebody has a cardiac arrest, they get coded and then it shows them walking down the aisle the next day getting married, and that's not real life.
What do advance directives have to do with Realities? Why do they matter?
Rebecca: The Realities presentation provides the knowledge of what an advanced directive is and why you need it, usually followed a week later by an advance directive workshop where participants can be helped with the document and have it notarized. We talk about the difference between an advanced directive and a POLST, and information about the importance of choosing your own surrogate.
Washington state law says that if you don't have anything in writing naming someone to speak for you about medical treatment, when you cannot speak for yourself, your spouse, parents, or siblings make the decisions. A lot of people don't realize a consensus is required among your surrogates.
Say you don't have parents, adult children or a spouse but you have siblings. I have five older brothers, and without a surrogate named in writing they would all have to agree about what treatments I receive. Without consensus, medical professionals are legally obligated to do everything they can to keep you alive.
Realities informs people that full treatment is default, even if it’s extremely painful, unlikely to succeed, and in the event of success, very unlikely to return you to a similar quality of life. And some of these treatments can be more than uncomfortable, appearing to professional care providers, physicians, and nurses to feel like torture.
Micki: One PeaceHealth employee said, 'I am a non-medical person. I hear all the time from medical professionals about the necessity for advance directives, but they don't give complete context for why. This talk is the important missing piece of the puzzle that puts all of it into perspective. I wish all of our patients and their families could see this presentation. It would make life better and easier for all of us.'
Should you attend Realities even if you already have your living will or advance directive completed?
Micki: Advance directives are important in addition to a will. Many people who attend Realities already have their advance directive filled out. Once they've heard the presentation they say, 'Whoa, I didn't understand what I picked and now I know and have to redo my advance directive.'
How do you think Realities presentations impact the community?
Rebecca: It's providing a huge opportunity for people to get questions answered, questions they might not be able to ask elsewhere. The presentations can last anywhere from an hour and a half to two hours because folks have a lot of questions and I don't cut people short; I answer their questions if I can.
Micki: For a long time, doctors weren't reimbursed for having these conversations. On January 1st of 2016, a billing code was implemented that allowed doctors to be reimbursed $86 for a 30-minute discussion, but you can't do it in 30 minutes. So, Realities is a needed layer of education.
Another way that this impacts the community is that more and more young people are becoming aware of the need for this kind of discussion. I actually think that the Realities model, not to inflate our importance, has now gotten attention throughout the state. In fact, there is a hospice nurse from Seattle, who came to one of Rebecca's presentations because she wanted to see what it was all about and now, she presents Realities in her area, with her iteration.
How do these presentations and workshops relate to Faith Community Nursing?
Rebecca: I look at being a faith community nurse (FCN) a little bit more broadly than just my congregation at Unity Spiritual Center, I see it as serving Whatcom County. Presenting Realities to the larger community is part of my health ministry.
Micki: One of the things that I have found in collaborating with Health Ministries Network is that because of who FCNs and health ministers (HMs) are, their grounding, they are able to share this message really effectively.
In working with the FCNs and HMs that I have, I’ve felt that the conversations they have about advance care planning are more poignant, they're deeper, and I think it’s because of their faith.
Rebecca: Working with faith community nurses in this project has been very beneficial. They’ve organized a time for us to come and talk, hosting the presentation and advance directive workshop in their churches.
What motivates the Realities team?
Rebecca: When my mother in law was diagnosed with pancreatic cancer she said, “I want hospice. I don't want any treatment.” She was in her 80's, she had heart failure and COPD. She knew treatment would probably be futile and she embraced the fact that she wanted the time she had left to be as good as it can be, and it was. It was really wonderful. My family members all took turns going to visit her, I cooked for her.
Her goal was to live to Thanksgiving and her doctor came to visit her a couple of weeks before and said, “I don't think she will make it to Thanksgiving.” So, we moved Thanksgiving up and we were all there with her.
As far as deaths go, it was a really good death. We all got to say goodbye. We got to have that last Thanksgiving dinner with her. All of her kids and grand-kids were with her.
That's what I wish for everybody, that they have the best death that they can have. We plan for the best party, the best wedding, the best vacation. Why can't we plan for the best death? Because it's all going to happen to all of us, 100 percent.
Micki: I asked our Realities presenters what motivated them to give this presentation and one said:
'I think for me, the big motivator to present Realities is to help deal with the moral distress I witnessed in families and experienced myself in the ICU setting. What was offered to patients by the health care community was often not realistic in terms of the patient's chances for a meaningful survival. Life was prolonged and everyone suffered. No one knew how to just tell people in simple, heartfelt words that there was nothing more we could or should do, and that comfort and peace should be the goal.
Too often we embark down the road of ‘do everything,’ knowing people had no clue what that meant, and it likely wasn't going to mean a return to any former meaningful life or health.
I feel by helping educate people in my community, I have somehow atoned for my part in what is wrong in our system.'
Medical professionals also suffer when we don't make decisions before it’s too late. I see advanced care planning as a shared responsibility. There are people who think, ‘oh, I'm not going to bring it up unless my doctor does.’ Well, you know what? It weighs on them, too. You bet it does.
What are some challenges in doing this work?
Rebecca: As a small group of volunteers, we can only do as much as we can. We all have other lives. I work full time, so I have to do this in the evening or on the weekends. There's more need in the community for this information than our team can do.
Micki: For me, one of the biggest challenges is to get more understanding from local organizations about why they should cooperate with us in getting the word out there.
Furthermore, we have no budget, it's just us. So, any printed materials, it doesn't come out of some deep pocket, it’s our investment. And that's not a complaint, it's just a challenge.
But, there are more opportunities than challenges. That's how I look at it, because if we didn't look at it that way, we’d just throw up our hands and say, “we’re done.”
How did Realities get started? How did it grow to what it is today?
Micki: My husband died on December 11th of 2013, and my family was all together, which was great. Prior we had told our kids to plan Christmas separately since my husband wasn’t going to be well enough travel. When he died, the kids said, 'We have to stay here.'
Believe me, you're in a fog if your lifetime partner has died, so I said, 'no, I'll be fine.' So, they kept their plans and I spent Christmas writing letters to the CEO of PeaceHealth, giving them my opinion on how to do more about this.
After a number of months, I saw a little blurb in the Bellingham Herald that two nurses were going to give a presentation at the Leopold that had to do with what goes on in the ICU. I went to it and listened to what they had to say.
Afterwards, I walked up to them and said, 'this message needs a wider audience, people need to know about this. If I'm willing to go out and generate interest, book venues, promote it, pay for flyers, would you be willing to give this presentation?' They said they’d have to think about it.
Anyways, we got together, and just by a coincidence, the day that we made our agreement was December 11th, one year after Bill died. We decided, ‘OK, full board.’ We jokingly called ourselves, 'three women on a mission' and we hit the ground running.
I'll tell you, when I first went out there to generate interest about this, I got blank stares. I went in person to places because if I sent an email explaining what it was, I got no response. In fact, I won't say which senior center, but there’s a senior center in Whatcom County whose previous director said to me, 'nobody's interested in that.'
To make a long story short, our first presentation was at the Bellingham Senior Center and it was standing room only, there were people sitting on the floor, out the hallway -- it was huge. That was the first one. Then after those nurses gave it 48 times, they decided it was time to pass the baton, and now it's Rebecca and Dr. Bill Lombard.
What’s upcoming for Realities?
Micki: Claudia, who was a WAHA advance care planning facilitator, has translated Dr. Lombard’s slides into Spanish. We're going to get a presenter who speaks Spanish and then Claudia will lead one of our advance care planning workshops in Spanish.
In 2020, we will offer Realities at St. Luke's Health Education Center on a quarterly basis and also at venues throughout Whatcom County. Realities is already scheduled for the Community Co-op, Congregation Beth Israel, and WWU. Other talks are in discussion, but firm dates have not been determined.
We plan to schedule more talks out in the county to better serve the under-served. Family Care Network is very interested in collaborating closely with us.
How can faith community nurses and health ministers and other get involved?
Micki: Our Realities team envisions a year-long 'challenge' among congregational health ministries in Whatcom County and beyond, championed by their faith community nurses and health ministers.
Each health ministry team could encourage their congregants to complete their advance directives. The faith community venue with the highest percentage of completed ADs would win some sort of prize -- to be determined!
We'd love to see faith community nurses and health ministers take a robust collaborative role with us in the challenge. In La Crosse, Wisconsin, 96% of decedents have a completed Advance Directive. In our region, we're above the national average, but compared to La Crosse, we are way behind, at about 25%. We can do better!
Interviewed by Sampson Alvarado on November 11, 2019.
Devotion
Courtesy of Rev. Dr. Cindy Bauleke, Health Ministries Network Spiritual Adviser
Friends, as we close one decade and begin another, we may have a variety of rituals to mark the new year. Many of us have just come through a season filled with wonder and joy, yet are also keenly aware of the sadness and grief of many at this time of year. Rather than making New Year’s Resolutions this year, my wish for you is to continue. To continue in the amazing work of healing of body, mind, and soul you do throughout the year in your community. In this spirit I share with you this poem by Maya Angelou:
My wish for you Is that you continue
Continue
To be who and how you are
To astonish a mean world With your acts of kindness
Continue
… To take the hand of the despised And diseased
and walk proudly with them In the high street
Some might see you and Be encouraged to do likewise
Continue
… To let gratitude be the pillow Upon which you kneel to Say your nightly prayer
And let faith be the bridge You build to overcome evil And welcome good.
Continue
… To dare to love deeply
And risk everything For the good thing
Continue
… And by doing so
You and your work Will be able to continue
Eternally.
Yes, there are times when we need a break, and we are wise if we recognize these times and honor them in our own lives and in the lives of others. There are other times when it is too much to do on your own. This is when we need to ask for help, to seek out others to join us in our continuing, to lighten the load and spread the love and healing.
I’ve been fortunate to work with teams of faith community nurses and health ministers, and I love the sharing and creativity that can happen in a team. As you Continue, perhaps you might wish to share your ministry with others on a team. If this appeals to you, watch for the Foundations course coming in the new year and encourage others to join you as you Continue in this sacred work of caring for God’s people.
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