Kimberly Russell, a staff chaplain in Spiritual Care Services, borrowed a watercolor paint palette from Child Life last summer for two weeks.
With watercolors and ink, she made pictographs. She wanted to help non-verbal patients express their spiritual needs and emotions. She filled the canvas with toys, musical notes, faces and other pictures.
“Some of the pictures are a lot more ambiguous than others," Russell said.
“How do you depict a blessing?” she asked. She was also concerned about the subtle distinction between an excited and embarrassed face.
Nevertheless, Russell persisted with the project until she crafted a two-sided board, a grid of spiritual care interventions on one side, commonplace emotions on the other. A patient or family member could simply point to one of the options or circle it with a marker to communicate their concerns.
A creative calling
Russell, who came to St. Jude in 2013, possesses a creative disposition. She regularly designs costumes and constructs not-so-ghoulish sets for Spiritual Care Services staff to dispense candy to patients at Halloween.
The idea for a pediatric board was inspired by New York-Presbyterian hospital chaplain Joel Berning who noticed that many patients couldn’t use words to express spiritual needs. Berning developed a spiritual care board for patients in the adult intensive care unit as a tool to help this group “voice” concerns.
"If we hear about something, we like to look into it," Russell said. "We thought this board could be a great thing for St. Jude."
It takes a team
Russell thought a spiritual care board would be a boon for pediatric chaplains. A child requiring mechanical ventilation in the pediatric intensive care unit could point to the board to ask the chaplain for a story. A family member could also use the board to ask for a prayer, a sacred book, or a connection to a local church, mosque or temple.
Russell knew that the adult board would need to be reworked for children at St. Jude. More child-friendly interventions, such as “praying in color” — a coloring intervention with journals and markers — needed to be added.
Chaplain and Director of Spiritual Care Services Brent Powell backed the project from the beginning. The other chaplains also contributed ideas and support.
The spiritual intervention board
St. Jude introduced the aptly named spiritual intervention board last summer in both English and Spanish versions.
The 25 interventions — blessing, baptism, candles, Communion, poetry and priest, among others — allow non-verbal patients or patients with reading difficulties to receive spiritual care adapted to their circumstances. Russell, ever mindful of patient autonomy, noted that the “talk with me” and “leave me alone” options bookend the first row of options. On the feelings side of the board, 24 emotions — happy, sad, afraid, mad and related sentiments — are depicted in simple line drawings of facial expressions.
According to Russell, both sides of the board help chaplains answer an important patient-care question: "Where do we go from here?"
The current board is a “first draft” that will be revised, Russell explained. But she has already experienced success using the board with patients.
She recalled a boy who didn’t like being the center of attention during a family meeting. After a brief explanation, Russell handed him the board. "You don't have to say a word,” she said. “You can just circle a face."
He used a marker to circle a face on the board’s laminated surface. Russell asked a few follow-up questions. Soon, with a few nods of his head, he communicated his concerns — being away from family, friends and favorite activities.
A performance worthy of acclaim
Russell majored in theater as an undergraduate student. She learned how to endure awkward silences and how to pay less attention to her internal dialogue.
She learned how to listen.
When a patient or family member tells a story, Russell obeys the first rule of improv and always says “yes.” And, if needed, she uses a little stagecraft. She knows that a carefully planned prop — a board, for example – might just keep the dialogue going.