spiritual care specialist

She enjoys biking, hiking, yoga and the arts. Accesses 28 Aug 2020, Puchalski C, Jafari N, Buller H, Haythorn T, Jacobs C, Ferrell B (2020b) Interprofessional spiritual care education curriculum: a milestone toward the provision of spiritual care. I specialize in LGBTQ+ affirming therapy and affirming letter writing. What Do Palliative Care Professionals Understand as Spiritual Care There is one test at the end of the course, and participants will have three attempts to pass or fail. Views expressed here do not necessarily reflect those of ScienceDaily, its staff, its contributors, or its partners. HHS Vulnerability Disclosure, Help Spirituality should be incorporated into care for both serious illness and overall health, according to a study led by researchers at Harvard T.H. doi: 10.1016/j.jpainsymman.2022.09.010. Spiritual Care Association Psychic Anna Love Specialist. Many national and international guidelines have been developed for addressing spiritual care as a part of whole-person care, especially in the field of palliative care. Ann Fam Med 2(4):356361, Meaningful Ageing Australia (2016) National guidelines for spiritual care in aged care. Spiritual Care at University of Utah Hospital In: National Consensus Project for Quality Palliative Care (eds) Clinical practice guidelines for quality palliative care, 4th edn. Spiritual Care in Health Care: Guideline, Models, Spiritual Assessment and the Use of theFICA Spiritual History Tool. 84132, Copyright 2023 University of Utah Health. Complex medical and mental health conditions, Sign up for our RN Virtual Lunch and Learn Tuesday, July 11 12 to 1 pm CT! Online ahead of print. The content of this course is applicable to pastoral caregivers as well as healers in a variety of settings. Torke AM, Varner-Perez SE, Burke ES, Taylor TA, Slaven JE, Kozinski KL, Maiko SM, Pfeffer BJ, Banks SK. All Other Spiritual Care: Call the Faith Line at 801-213-2484 to make a request of the hospital chaplains. 2021 Winter;35(1):4-8. Do you long to remember who you really are, what you really want, and how to get your life back on track? Google Scholar, Best M, Butow P, Olver I (2015) Do patients want doctors to talk about spirituality? This site needs JavaScript to work properly. Spiritual care at the end of life in the primary care setting This curriculum is built on a pilot Interprofessional Spiritual Care Education Curriculum (ISPEC) course held at the Veterans Administration, DC. Our spiritual care team also provides guidance on ethical issues including organ donation, life-support and end-of-life issues, as well as grief counseling. Smyre CL, Tak HJ, Dang AP, Curlin FA, Yoon JD. Are you ready to heal your relationship with yourself, others, and other important aspects of your life? The chaplain is the spiritual care specialist on the healthcare team and has the training necessary to treat spiritual distress in all its forms. Mrs. Rose Davis is here to help guide you through these uncertainties, so you know what your, Clairvoyant Psychic Medium offers the following: Personal readings in Love-Career-Life-Spirituality-Missing Persons, Unsolved Cases. Australian Patient Preferences for Discussing Spiritual Issues in the Hospital Setting: An Exploratory Mixed Methods Study. Do you long for healing and empowerment? In: Hutchinson TA (ed) Whole person care, vol 1. We believe that by using holistic approaches we create a brave and safe space to explore ourselves. 2012 Sep 15;86(6):546-50. "This study represents the most rigorous and comprehensive systematic analysis of the modern day literature regarding health and spirituality to date," said Tracy Balboni, lead author and senior physician at the Dana-Farber/Brigham and Women's Cancer Center and professor of radiation oncology at Harvard Medical School. (212) 644-1111 Spiritual needs may include unresolved life questions, such as how a patient should make sense of their mental health situation or how they define good and bad. Chaplains themselves represent a variety of spiritual backgrounds, including secular and religious. I have dedicated my career to helping survivors of abuse heal. Online ahead of print. 2021;35(1):4-8. Find Spirituality Therapists, Psychologists and Spirituality Counseling in Salt Lake City, Salt Lake County, Utah, get help for Spirituality in Salt Lake City. Acad Med 89(1):1016, Puchalski CM, Vitillo R, Hull SK, Reller N (2014b) Improving the spiritual dimension of whole person care: reaching national and international consensus. Pediatr Blood Cancer. An Analysis of Chaplains' Narrative Chart Notes Describing Spiritual Care Visits with Gender Affirmation Surgical Patients. That's why we provide multi-faith support and guidance to our patients, their families and employees, as well as connections to the larger faith community. Online ahead of print. The information gleaned from the conversation can guide further medical decision-making, including but not limited to notifying a spiritual care specialist. We have a rigorous accreditation and certification process for centers and educators that provide CPE. Accesses 28 Aug 2020, NCCN Guidelines for Patients: Distress. I use a holistic approach in working with my clients with the goal of teaching them to use their mind body and spirit for healing and growth. Implementing quality improvement efforts in spiritual care: outcomes from the interprofessional spiritual care education curriculum. In addition to my work as a psychotherapist, I also provide Life Coaching to assist individuals in 6 life areas: Relationships, Money, Physical Health. "There was a dawn remembered when my soul heard something from your soul" - Rumi - The therapuetic encounter allows for the kind of "dawning" which Rumi alludes to. I listen, I observe and reflect back to you. Who coordinates a plan to help clients achieve their goals. Coats H, Paganelli T, Starks H, Lindhorst T, Starks Acosta A, Mauksch L, Doorenbos A. J Palliat Med. Transgend Health. An official website of the United States government. Paper presented at: WHO sixty-seventh world health assembly 2014. 2022 Mar;69(3):e29515. Accesses 28 Aug 2020, Shukla S (2020) Spirituality in Ayurveda. Chaplain Bonnie is an ordained Interfaith minister who identifies as deeply spiritual and religiously eclectic. Spiritual care specialists, such as chaplains, are trained to provide clinical pastoral care to diverse patients-whether spiritual-not-religious or from various religious traditions. Would you like email updates of new search results? The depth of our training enables students to realize their full potential to strengthen the spiritual health of people in their care as well as themselves. This model of interprofessional care developed following these guidelines is based on a generalist-specialist model of care: providers address spiritual concerns and work with spiritual care specialists in treating spiritual distress and helping enhance spiritual well-being. This could include organized religion but extends well beyond to include ways of finding ultimate meaning by connecting, for example, to family, community, or nature. Springer, Chapter, pp 18, Koenig HG, McCullough ME, Larson DB (2010) Handbook of religion and health. Unauthorized use of these marks is strictly prohibited. Unable to load your collection due to an error, Unable to load your delegates due to an error. J Relig Health. While most physicians would agree that spiritual well-being is an important factor in their patients' health, the spiritual needs and well-being of patients are largely ignored and rarely addressed by healthcare providers, representing a significant gap in care. Spirituality linked with better health outcomes, patient care. Clients values and beliefs are integrated into plans of care. pastors, chaplains and seminaries to provide coaching and clinical Pastoral Education. 2018 Mar;55(3):897-905. doi: 10.1016/j.jpainsymman.2017.10.015. Best MC, Jones K, Merritt F, Casey M, Lynch S, Eisman JA, Cohen J, Mackie D, Beilharz K, Kearney M. J Relig Health. (eds) Spiritual Needs in Research and Practice. Religions 9:13. https://doi.org/10.3390/rel9010013, Clark D (2014) Total pain: the work of Cicely Saunders and the maturing of a concept. Please enable it to take advantage of the complete set of features! Spiritual Care Specialist Jobs, Employment | Indeed.com Process Indicator 2.B. SCC is proud to offer resources and training to churches to better prepare them to provide ministry to the communities in which they serve. Design: The curriculum was designed for classroom and online learning. You are welcome to appreciate the original encaustic art and enjoy the piano. Professional, board certified chaplains cultivate relationship, offer compassionate listening, and foster healing and wholeness. Spiritual Care - an overview | ScienceDirect Topics Spiritual Care in Health Care: Guideline, Models, Spiritual - Springer over 3500+ products. Course leads to a certification (intro to chaplaincy), SCC is fully accredited under Clinical Pastoral Education International (CPEI) www.cpei.us. Balboni, VanderWeele, and Koh are also co-chairs of the Interfaculty Initiative on Health, Spirituality, and Religion at Harvard University. Hours for the Reflection Room are 6 am9 pm. You may be struggling with depression, anxiety, and other mood issues as a result. Advice to Limit High-Fat Dairy Foods Challenged, Why No Kangaroos in Bali; No Tigers in Australia, New Route for Treating Cancer: Chromosomes, Giant Stone Artefacts Found: Prehistoric Tools, Most Distant Active Supermassive Black Hole, Holograms for Life: Improving IVF Success, Grocery Store Carts Set to Help Diagnose Common Heart Rhythm Disorder and Prevent Stroke, DNA Can Fold Into Complex Shapes to Execute New Functions, AI Tests Into Top 1% for Original Creative Thinking, Everyone's Brain Has a Pain Fingerprint -- New Research Has Revealed for the First Time, Scientists Discover Spiral-Shaped Signals That Organize Brain Activity, Amputees Feel Warmth in Their Missing Hand, Why Do Champagne Bubbles Rise the Way They Do? The .gov means its official. Rogers Behavioral Health Foundation is registered as a 501(c)(3) nonprofit organization. J Pain Symptom Manage. J Palliat Med 23(6):777784, Selman LE, Harding-Swale R, Agupio G, Fox P, Galimaka D, Mmoledi K, Higginson I, and the Spiritual Care in sub-Saharan Africa Advisory Group (2010) Spiritual care recommendations for people receiving palliative care in sub-Saharan Africa: with special reference to South Africa and Uganda. Or, a person may be looking for the continued sense of hope and community offered by their religion, which spiritual care can offer. 2016). I have extensive knowledge in addiction, codependency, trauma, depression and anxiety. It is important to know two things: 1. you are not alone, 2. challenges are always opportunities to grow and change your life. We can get overwhelmed by anxiety and sadness, especially when we experience loss and transitions. Religious involvement, spirituality, and medicine: implications for clinical practice. The site is secure. Life offers us challenges and opportunities. MeSH Spiritual Care: The Role of Health Care Chaplaincy | SpringerLink Hours for the Infinity Chapel are 6 am9 am, 11 am1 pm, and 6 pm9 pm. She is fluent in Spanish. Chaplains also provide spiritual counsel, and facilitate ritual practices including prayer or meditation, mindfulness, and the arts to help you connect to the Sacred. PubMedGoogle Scholar. http://nchpc.conferencespot.org/67968-nchpc-1.4266595/t009-1.4266773/f009-1.4266774/a054-1.4266785. My specialties include: sexuality, gender identity, relationships. Epub 2021 Aug 15. Although the overwhelming majority of healthcare providers agree that they should be aware of patients' spiritual beliefs, that these beliefs may influence their healing, and that patients benefit from spiritual care, there remains considerable debate about who should inquire about spiritual beliefs and deliver spiritual care. The community based chaplain course is taught by trained CPE supervisors and will be a great introduction to CPE. and transmitted securely. We are happy to set up a consultation to determine your needs and how we can best serve you. Then we grieve together the past and implement interventions and boundaries for a healthy future. Seeing the physician as the generalist in spiritual care and the chaplain as the specialist is a helpful model. Spirituality and Aging Course for Nurses and Social Workers Initiatives such as the ISPEC curriculum have been developed to train clinicians in interprofessional spiritual care. Muslim Prayers: Prayer rugs are available for use in the Reflection Room located on the Level A of the hospital (on your left as you walk toward the cafeteria). BMJ 343:d4163, Hutchinson TA (2012) Whole person care. Adv Mind Body Med. Get a glimpse into your future with Tarot card readings from The Quantum Qabalah and Tarot by Frater Akiba in Salt Lake City, Utah. "Overlooking spirituality leaves patients feeling disconnected from the health care system and the clinicians trying to care for them," said Koh. Spiritual Consultants Psychics & Mediums Palmists. Spiritual care in nursing: an overview of the measures used to assess I also have special insight into trauma, depression, anxiety, relationship issues, meaning and identity, international populations, women's issues, and. Process Indicator 2.G. and transmitted securely. Spirituality linked with better health outcomes, patient care It is not intended to provide medical or other professional advice. MeSH Through self-reflection, compassion, emotional-regulation, acceptance of diverse perspectives, decisiveness, counseling, and. Catholic Mass: Wednesdays at 10:15 am in the Infinity Chapel. Spiritual Care Specialist jobs Sort by: relevance - date 3,305 jobs Dialysis Registered Nurse The Omaha Tribe of Nebraska Sioux City, IA $68,640 - $72,800 a year Full-time Monday to Friday + 3 LCSW Therapist SAC Health System San Bernardino, CA 92410 (Stadium West area) San Bernardino - Downtown Metrolink Station $94,265 - $115,475 a year Full-time Chaplain Luana is an ordained Presbyterian minister who values storytelling as a way for people to come to understand the meaning of their experiences and relationships, and especially their relationship to the Holy. FOIA 8600 Rockville Pike Eating Disorder Recovery Residential Care, Nashotah Center for DBT Adolescent Residential Care, Chapel, including a spiritual resource library (West Allis, Brown Deer, and chapel coming soon to Oconomowoc), On site ecumenical worship services (Ash Wednesday, Good Friday, Easter, Christmas), Transportation to churches for worship (in selected programsand not occurring during the COVID-19 pandemic), On site one-on-one sessions with community clergy (not occurring during the COVID-19 pandemic). 8600 Rockville Pike Pastoral leadership coaching follows the same coaching style as the professional sector, however, the coaching is focused on the stewardship of potential within the pastor in order for the pastor to uncover their ministries potential.. Have you felt called to serve your church, your community or local hospital at a higher level? Szilagyi C, Lion AH, Varner Perez SE, Koch S, Oyedele O, Slaven JE, Montz K, Haase JE, Puchalski CM. Epub 2022 Dec 14. The conference also endorsed the important role of the board eligible or board certified chaplain as the spiritual care specialist in clinical care with the other clinicians being the generalists, in a generalist-specialist model of care. Canadian Association for Spiritual Care / Association canadienne de soins spirituels ("CASC," "CASC/ACSS," "Association") is a national multi-faith organization, committed to the professional education, Certification and support of people involved in spiritual care, psycho-spiritual therapy, education and research. Am Fam Physician. These guidelines focus on the clinical aspect of spirituality, identifying spiritual distress as a clinical symptom to be assessed and treated. While coaching, he is quick to pick up on limiting beliefs and excuses that keep leaders from reaching their potential. Chan School of Public Health. 2005 Summer;44(2):137-46. doi: 10.1007/s10943-005-2772-2. Religious commitment is intrinsically connected to cultural, mental, spiritual, and societal aspects of wellness, and, thus, should be better recognized by the medical community, whose goal is to provide culturally competent, relationship-centered healthcare. According to the International Consensus Conference on Spiritual Care in Health Care, spirituality is "the way individuals seek ultimate meaning, purpose, connection, value, or transcendence." This is done by learning a new skill or capability to achieve personal objectives. Federal government websites often end in .gov or .mil. See more therapy options for Salt Lake City. At Therapy Transformed we focus on multiple areas of personal growth and encourage individuals to seek proactive care with one of our many therapists. Handb Clin Neurol. https://doi.org/10.1177/2374373518786013, HH Dalai Lama (2006) Forward in time for listening and caring. Accessed 4 June 2020, Powell LH, Shabbi L, Thoreson CE (2003) Religion and spirituality linkages to physical health. Information is provided about the availability of spiritual care services. Clinical Social Work/Therapist, LCSW, MSW. Cicely Saunders International, London. Consensus implications included incorporating considerations of spirituality as part of patient-centered health care and increasing awareness among clinicians and health professionals about the protective benefits of spiritual community participation. What is the role of spiritual care specialists in teaching generalist The https:// ensures that you are connecting to the Spirituality in general practice: a qualitative evidence synthesis. Latter-day Saint Sacrament Meeting: Sundays at 11 am in the Infinity Chapel. The https:// ensures that you are connecting to the I am comfortable working with adults, families, couples and LGBTQ community. official website and that any information you provide is encrypted The use of spirituality and religion in coping with illness is widespread among primary care patients. The Spiritual Care Center, LLC is an education, training and counseling center accredited by Clinical Pastoral Education International (CPEI). Healthcare Providers' Perceptions about the Role of Spiritual Care and Chaplaincy Services in Substance Use Outpatient Treatment. Upon successful completion, students earn a certificate of completion and continuing education hours. Spiritual care specialists, such as chaplains, are trained to provide clinical pastoral care to diverse patients whether spiritual-not-religious or from various religious traditions. Find new understanding and deeper connections through therapeutic activities and experiences. Online ahead of print. The chaplain is the spiritual care specialist on the healthcare team and has the training necessary to treat spiritual distress in all its forms. 4. We may live and work in systems that do not support our well-being. Other Harvard Chan co-authors include Stephanie Doan-Soares and Katelyn Long. Spiritual care can address spiritual or religious needs during treatment. 2022 Feb 14;7(1):92-100. doi: 10.1089/trgh.2020.0030. Int J Environ Res Public Health. FOIA Bethesda, MD 20894, Web Policies The .gov means its official. You are invited to write prayers and deposit them in the secure prayer wall. The prayers are honored by the Spiritual Care Team and ritually released. My experience and training in mindfulness, relationship issues, shame and vulnerability, womens issues. Coach Scott wants to help you bridge the gap between where you are now and where you want to be in your business, ministry and/or family life so you can operate at a higher level. The Nature of Religious and Spiritual Needs in Palliative Care Patients, Carers, and Families and How They Can Be Addressed from a Specialist Spiritual Care Perspective by Kate L. Bradford Westmead Hospital, Cnr. 8600 Rockville Pike All other marks contained herein are the property of their respective owners. The site is secure. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 50 N. Medical Drive New York, NY 10018 Why choose Coach Scott? 2011 Nov;61(592):e749-60. Some aspects of our story may continue to cause pain, cause embarrassment, induce shame or guilt, keep us from fulfilling our sexual potential, block us from feeling whole or cause ongoing problems in our most intimate relationships. ", "Spirituality is important to many patients as they think about their health," said Tyler VanderWeele, the John L. Loeb and Frances Lehman Loeb Professor of Epidemiology in the Departments of Epidemiology and Biostatistics at Harvard Chan School. There are several treatments that incorporate spirituality. What Every Health Care Professional Needs to Know About Spiritual Care April 1, 2021. Pain Practice: The Official Journal Of World Institute Of Pain 15(7):671687, Hadi MA, McHugh GA, Closs SJ (2018) Impact of chronic pain on patients quality of life: a comparative mixed-methods study. The anamnestic spiritual history tool FICA can be used by clinicians to assess spiritual distress and spiritual resources of strength. While in our care, patients have access to the following resources, depending on theirtreatment goals, program, and medical status, and location: Each member of the spiritual care team has advanced training, preparing them to use an inclusive approach in meeting patients, wherever that may be, on their spiritual path. Process Indicator 2.F. Together we'll bring awareness to your thoughts, feelings, emotions, body sensations, values, desires, memories and more, to deeply understand what its like for you to be you. You may sit quietly, or make use of one of the prayer rugs. The 27-member panel was composed of experts in spirituality and health care, public health, or medicine, and represented a diversity of spiritual/religious views, including spiritual-not-religious, atheist, Muslim, Catholic, various Christian denominations, and Hindu. 2023 Feb 20. doi: 10.1007/s10943-023-01767-x. The Spiritual Care Association Nursing Division is accredited as a provider of nursing professional development by the American Nurses Credentialing Center's Commission on Accreditation. Bethesda, MD 20894, Web Policies Layers of Loss: A Scoping Review and Taxonomy of HD Caregivers' Spiritual Suffering, Grief/Loss and Coping Strategies. We can also connect you with faith-based resources and clergy in the community to meet tradition-specific spiritual needs while you are here. Citation 14 Finally, the participants cited the importance of spiritual development as part of clinicians . I work with a broad range of sexual issues, including out of control sexual behavior/sexual addiction, post cancer-sex, erectile dysfunction, rapid/early ejaculation, vaginismus/dysperunia, safe sex, infidelity, loss of desire, gap in desire, kink/BDSM, LGBTQ+, polyamory, pornography concerns, and resolving conflict between. Latter-day Saint Sacrament Meeting: Sundays at 11 am in the Infinity Chapel. The Pastoral Care Specialist (PCS) Training Program is a 48-hour spiritually-integrated mental health first aid course that provides the knowledge and skills that churches and communities need to help others effectively, ethically, and safely. Ginger sees humor as her advantage for survival, resilience, and hope for the future.`. Epub 2022 Oct 2. She grew up Protestant Christian, attended Catholic high school, and is a devotee of Peruvian shamanism. Over the years, I have developed my gift of psychoanalysis which helps me to diagnose my patients in an accurate and easy to understand manner for them. All clinicians require education and support to provide this care to patients and their families facing serious illness. "Healing Services" is a program that combines a variety of specialist therapies integrated with the spiritual care provided by chaplains . What lessons am I meant to learn in this lifetime? Process Indicator 2.F. 2022 Jul 19:1-13. doi: 10.1080/08854726.2022.2097781. Hirschmann J, Kozato A, Sharma V, Villagra C, Wetmore J, Jandorf L, Pang JH, Reynolds M, Dodge L, Meja S, Safer JD. Meridian Counseling: Individual & Family Therapy, Pearson Psychological and Evaluation Services, Beginning where you are, I can help you address: desire discrepancies, orgasm concerns, painful sex, ED/premature ejaculation/delayed ejaculation, problematic sexual behavior, LGBTQ issues (orientation/concerns, transitioning MTF/FTM), intimacy concerns, infidelity, sexuality in a conservative culture, trauma, resolving conflicts between. LegitScript certification demonstrates that Rogers Behavioral Health complies with LegitScripts certification standards, which help ensure transparency and compliance with applicable laws and regulations. Scott is a certified John Maxwell leadership and life coach, Major in the United States Army, Army Reserve Chaplain and holds two Masters degrees. Spiritual care is a vital component of palliative care. Spiritual Needs in Research and Practice pp 2745Cite as. We integrate aspects of Buddhist philosophy. eCollection 2022 Feb. Leidl BF, Fox-Davis D, Walker FO, Gabbard J, Marterre B. J Pain Symptom Manage. An Integrative Review of Qualitative Literature. Aligns with the following Quality Indicators in What is Quality Spiritual Care in Health Care and How Do You Measure It? Clipboard, Search History, and several other advanced features are temporarily unavailable. 2001 Dec;76(12):1225-35. doi: 10.4065/76.12.1225. 2006 Sep-Oct;12(5):398-416. doi: 10.1097/00130404-200609000-00009. I love working with clients who are going through life transitions and maneuvering through change, whether that change is having children leave the home, relational, heading to college, coming out or faith transitions, to list a few. Epub 2022 Jul 27. Call the Faith Line at 801-213-2484 to request that a name be added to the visitation list. https://doi.org/10.1186/1471-2318-10-88, National Consensus Project for Quality Palliative Care (2020) Domain 5: spiritual, religious, and existential aspects of care. Spiritual care specialists, such as chaplains, are trained to provide clinical pastoral care to diverse patients-whether spiritual-not-religious or from various religious traditions. . Whether you are walking away from an abusive situation, coming to terms with your identity, or working through childhood trauma, you could use a guide. Spiritual care | Ascension Bookshelf Professorship Quality of Life, Spirituality and Coping, Faculty of Health, Witten/Herdecke University, Herdecke, Germany, IUNCTUSCompetence Center for Christian Spirituality, Philosophical-Theological University of Mnster, Mnster, Germany, 2021 The Author(s), under exclusive license to Springer Nature Switzerland AG, Puchalski, C. (2021). Chaplains themselves represent a variety of spiritual backgrounds, including secular and religious. Unauthorized use of these marks is strictly prohibited. government site. Harvard T.H. The framework of spiritual care specialists and generalists is a helpful way to understand spiritual care provision in health care settings. "Focusing on spirituality in health care means caring for the whole person, not just their disease.". People who experience serious spiritual distress tend to have poorer quality of life, and greater depression and anxiety. It is hard to be a human sometimes. FOIA Recognizing Spiritual Distress: What Caregivers Need to Know PMC Number of Continuing Education Hours for Spiritual Care for Social Workers: TBA. Spiritual care is an essential aspect of whole-person health care. Epub 2016 Nov 1. This includes lived experiences, hopes for your future, traumas, dreams, external/internal oppressions, body sensations. J Pain Symptom Manag 55(3):10351040, Maugans TA (1996) The SPIRITual history. This intro to chaplaincy training will give you the basics to get started and set you up for success with Clinical Pastoral Education. 14 measures relating to spiritual care and assessment were identified covering the key domains of: 'Beliefs and values and attitudes around spiritual care,' 'Frequency of provision or extent to which they provide spiritual care or willingness,' 'Respondents' level of knowledge around spirituality and spiritual care,' 'Ability to respond to spiri.
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