MedEdPORTAL (Oct 2009)
David Helechet: A Case Concerning the Benefit of Spiritual and Cultural Belief Assessment in Post Traumatic Recovery
Abstract
Abstract Introduction In 2006, when we searched for well-developed cases with a spiritual theme, we found very little. Most were typical cases with a spiritual issue added. Therefore, we decided to create a case ourselves. The storyline of our case demonstrates the power of meaningful ceremonies and rituals to foster patient healing. The encounter gives the learner an opportunity to practice communicating about spirituality and cross cultural issues in a safe environment. It also seeks to stimulate curiosity so that the learner may inquire, “How did this person become well?” Methods This resource is a two-station standardized patient (SP) encounter that presents the before-and-after scenario of a Native American veteran suffering from a conversion disorder emanating from traumatic stress and the impact of ritual and ceremony on his health outcome. The target audience is Year 4 medical or osteopathic students, residents, nurse practitioner students, and physician's assistant students. The first station presents an SP who is wheelchair bound following severe torture; at the second station, the SP stands to greet the learner and thank him/her for support with his care decisions. Learners must utilize their skills in spiritual history taking to understand the course of his medical condition. Results Due to the low number of participants in our pilot process, we conducted a group debriefing of the encounter with the residents. They felt the case presentation was authentic/believable and the medical records were thorough and realistic. Utilizing the SP testing process, the residents all arrived at the same logical conclusion concerning the patient's treatment plan, thus adding a measure of reliability to the process. Discussion It is extremely helpful if the school has an SP training program and the SP chosen has sufficient skill to portray different mannerisms, characteristics of the pathology, and emotional states across the two encounters. A wheelchair is needed for the first encounter. Optimally, three small private rooms are required: station 1, station 2, and a space for writing notes. We chose not to have the learner perform a physical exam so that he/she could focus on obtaining a spiritual history, which is key to understanding the case's outcome. We recommend a total time of 55 minutes distributed as follows: 5 minutes—records review, 20 minutes'station 1, 10 minutes—patient note, 10 minutes'station 2, 10 minutes—reflective writing. It is helpful to work with faculty who have experience with/knowledge of the Veterans Affairs Medical System, Native American traditions, and cross-cultural issues. Residents were confused as to what to do when all avenues for usual medical treatment seemed to have been completed with no success. We had hoped they might turn to their training in spiritual assessment; we had even told them the case was set up for the purpose of understanding spiritual assessment. Still, they had difficulty sorting out spiritual issues from psychological and social issues. Residents with multiethnic personal histories demonstrated enhanced sensitivity to spiritual beliefs and cultural practices with this patient. We encourage others to utilize our case so that more data can be gathered on its impact.
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