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Tuesday, May 13
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 Brenda Presha
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Rx for Better Patient Outcomes: Pastoral Care
Originally published in Atlanta Hospital News, April 2006
By Bonnie Alkema, RN
Brenda Presha would like to see doctors start writing prescriptions for spiritual care. “When patients come to a physician, they don’t check their spirituality at the door,” she says. “We live holistically. We’re looking for physical care, yes, but also for social and spiritual care.”
Presha (pronounced pre-SHAY) says spiritual care in the healthcare environment means helping a patient find meaning in a new diagnosis or prognosis, or exploring the question, “Why did this happen to me?”
“‘Why me?’ is a fundamental question for anyone in a medical crisis, regardless of his or her religion,” says Presha, bereavement and volunteer services manager for VITAS Innovative Hospice Care® of Atlanta. “By finding meaning we find hope, and hope helps promote healing. So write an order for a spiritual prescription,” she urges physicians and nurses, “and hand it over to the pastoral care department.”
Presha’s experience as a chaplain at several Atlanta hospitals has served her well in her grief and loss work with hospice patients and their families. In acute care settings, chaplains may make rounds, go to the ER or visit the outpatient unit. “Referring patients to a chaplain is not always a part of the plan of care,” she says. “Chaplains might be called if someone codes, or there is an accident, or a patient is taken off a ventilator.”
That’s not enough, she says. “Doctors have an opportunity to invite their spiritual team to partner with them in the patient’s care plan. Before a chaplain can see a patient with a long term chronic illness, or because lab results are unfavorable, or because there’s a change in prognosis, an assessment has to be prescribed. A doctor’s openness to that is as important as stopping the bleeding, running the tests or ordering the chemo.”
Although chaplains are trained in all religions, Presha acknowledges that no chaplain is a replacement for the patient’s own faith leader. But chaplains know what is needed at the bedside.
“In a first visit the chaplain identifies what the patient needs, and may call the patient’s priest, imam, rabbi or minister to perform a sacrament or ritual,” she explains. “But in the meantime, the chaplain can be present with the patient and family, allow them to feel loved and respected, process what’s happening and give it meaning—and give them dignity.
“Active listening and ministry of presence affirm the worth of a person,” Presha continues, “Listening, reflecting back and clarifying help patients and families process their feelings. It’s the art of meeting people where they are.” And who, she wonders, would do that if the chaplain were not called? “Too many people ignore the elephant in the room,” she says. “Chaplains are trained to facilitate conversation about the elephant, and to find meaning in the experience.”
Presha says there can be a learning curve before a physician or nurse knows when spiritual care is necessary. A new prognosis is a red flag, but psychosocial issues such as concurrent losses related to divorce, financial hardship or recent deaths in the family can be indications. Even in day surgery there can be a need for pastoral care, depending on the patient’s resources, coping skills and support system.
Presha recalls a tragic incident in an ICU for which a chaplain was called to do the impossible. A 17-day-old infant was admitted with a crushed skull. The mother was a teenager; there was a boyfriend involved. For a week the staff kept the baby alive and dealt with the family. There was caregiver breakdown; the staff was exhausted and angry.
The chaplain dealt with both the family and the staff. When they took the baby off life support, there was a service. “Everybody had cried,” recalls Presha. “Everybody had anguished. There would be further legal repercussions. But because there was a support system in place, it helped people to face what was to come. We’d come to terms with some issues, and there was hope. And that’s what chaplains do.”
Brenda Presha Certified in Thanatology
Brenda Presha, MDiv, BCC, CT, bereavement and volunteer services manager for VITAS Innovative Hospice Care® of Atlanta, was recently Certified in Thanatology (CT): death, dying and bereavement. A bereavement counselor for 12 years, Presha has facilitated support groups in parenting, marriage and grief, and has provided individual and crisis counseling at Mount Paran Counseling Center in Atlanta. As an expert in death and dying, Presha speaks at local civic groups and churches.
Presha graduated from the Church of God Theological Seminary in Cleveland, Tennessee, and has a counseling certificate from the Psychological Studies Institute in Atlanta. She completed her residency at the North Atlanta Tri-Hospital Clinical Pastoral Education (CPE) Center and an internship in CPE at Emory Center for Pastoral Services at Emory Crawford Long Hospital, Atlanta.
She is a Board Certified Chaplain (BCC) endorsed by the International Church of God Chaplains Commission, directed by CPE Supervisor Dr. Robert Crick.
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