One of the nursing homes I visit frequently to see Hospice patients is three floors tall and has elevators for staff and visitors to use.  Each entrance to the elevator has a combination key pad where you have to enter the proper sequence of numbers before you can “call” the elevator to your location.

Residents of the nursing home who would like explore on their own are frequently sitting or standing near the entrances in the hopes of hitching a ride with someone who can enter the proper code.  In some situations residents insist on boarding the elevator with me.  If I can’t verbally convince them to stay on their floor and not board the elevator, I have to let the doors close, go find a staff member to deal with the resident, so I can enter the elevator without aiding a resident in an escape.

The residents have the most “hurt feeling” expressions on their faces when they see I don’t want to let them onto the elevator.  It makes me feel like an “Enforcer”.  I guess that is because I frequently ask my Hospital patients, “How can I help you today?” with the intention to granting their request if it is allowable for me to do so.  At the Hospital I rarely have to say “No”.  Many times I have to say that I will check before doing what they ask me to do, and other times I say I will get someone else to help that is better trained for what they need.  But I don’t just say “No”.  Hospitals and Nursing Homes vary in many respects; this situation is just one of the ways in which the cultures differ.  I just have to remember when I am denying a resident access to the elevator I am doing the best thing for the safety of the resident.

With all of the advances in health care that have been made in the last 50 years many illnesses and injuries can be healed.  I sometimes find patients who are surprised that with their specific medical history there is not an ideal outcome for their illness.

These patients feel depressed, frustrated, and express very little hope for their future.  There are options on how these emotions can be processed.  Some patients blame themselves, others blame God, and sometimes the patient blames the health care team.

As I work with patients in these situations I try to move them away from “The Blame Game”.  My experience has shown me that spending your time and energy deciding who to blame and what reasons you have to blame them does not make you feel better about your situation.  I try to move the patient to thinking about what he or she wants to do with the new reality that is suddenly before them.  In almost every situation the patient still has options.  One example of this is whether they would like to go to a nursing home or go back to their own home with the assistance of Home Care or Hospice.  Some patients choose the nursing home because they do not want their family members to have to care for them at such an intensive level.  Others choose to home because being in their own surroundings and being cared for by those who love them is what they want.

There are no “right” and “wrong” answers in these situations.  What is available is choice, and it is the right of the patient to make the choice that they feel is best for their situation.  Once people see they have choice, their perceived need to place blame frequently either diminishes in intensity or disappears totally.  A chaplain along with other health care team members serves the needs of the patient as we help them make choices along their journey.

The emoticons shown above are used in social media as we put a visual label on how we are feeling at the moment.  Knowing how we are feeling at any given moment is important.  Did you know there is a scale to measure how you are feeling?  It works like a credit score works.

Television commercials continue to remind us that we each have a FICO credit score.  This score is designed to help lenders determine the likelihood that a borrower will repay a loan according to the terms established when the credit was granted.

As a chaplain, I have little use for the FICO score as I work with patients and visitors.  I do use the SRRS scale as I visit with patients.  It helps me assess how well the person is coping with the life events they are describing to me.  The SSRS is officially the “Social Readjustment Rating Scale”, more commonly known as the Holmes and Rahe Stress Scale.  It was created to help us measure the stress load we carry, and think about what we should do about it.  The scale has 43 indicators.

I don’t literally ask people all 43 questions.  As they tell me about their situation, I listen and mentally tally a score associated with the life events they describe.  I use this to determine what tools of spiritual care would be most effective for them.  It also helps evaluate my frequency of visits, given I don’t have time to visit every patient every day.

• If your total score is in the 11-150 point range you have only a low to moderate stress level.
• If your total score is in the 150-299 point range you have a moderate to high stress level.
• If your total score is in the 300-600 point range you have a high or very high risk stress level.

If you would like to take the test yourself, you can find it at the website below:

http://www.mindtools.com/pages/article/newTCS_82.htm