Thursday, August 21, 2014

Standards of Practice for Professional Chaplains in Hospice and Palliative Care Part 2

My method for commenting on this section of the Standards of Care will be to follow the Standard with comments in italics. I am grateful that this Standard has come out and was accepted recently. Further, it must be noted that the arena of chaplaincy that has grown the most in recent years has been that of hospice chaplaincy. In my opinion what will elevate hospice chaplaincy to a more credible level of recognition is the requirement of not only an MDiv. or similar Master’s degree, but also, the requirement of 4 units of Clinical Pastoral Education and Board Certification from one of the major certifying bodies. The work of the hospice Chaplain is challenging as end-of-life issues are complicated. Chaplains engage patients for up to a year or more or for just a few days. Managing the relational aspect of spiritual care requires a highly competent Chaplain. My bias is obvious. But, I don’t apologize. Patients and family caregivers need the best we can offer. The crucible of CPE and the experience of Board Certification develop mettle in the life of the Chaplain that serves patients and caregivers well in the hospice dynamic. Section 1: Chaplaincy Care with Patients and Families Standard 1, Assessment: The chaplain gathers and evaluates relevant data pertinent to the patient’s situation and/or bio-psycho-social-spiritual/religious health. Through use of the Spiritual Plan of Care, the Chaplain addresses many issues in his initial and subsequent assessments. The Chaplain identifies a Spiritual Concern then works with the patient and caregiver to negotiate what it is that they desire as an Outcome or Goal of Care. From there, the Chaplain wisely uses Interventions to attempt to meet that Outcome. This is just the beginning of the clinical aspect of hospice chaplaincy. Standard 2, Delivery of Care: The chaplain develops and implements a plan of care to promote patient well-being and continuity of care. The initial assessment creates the Plan of Care. While the Chaplain has some direction as to what the patient desires for an Outcome, she moves toward that goal at the behest of the patient. In other words the Chaplain serves the agenda of the patient, not vice versa. There will be those visits in which the patient just needs to talk … about anything else but spiritual matters … and that is ok. The entire goal is patient well-being. Counter-transference issues can cause a Chaplain to be anxious and that anxiety has a way of spilling into the pastoral encounter and, in so doing, skew the conversation away from the agenda of the patient. A Chaplain who is self-aware will carefully guard against this. There is no such thing as “I have to talk about this or that or the other” in hospice chaplaincy. A calm demeanor is what the successful Chaplain brings to the visit. Standard 3, Access to Information and Documentation of Care: The chaplain, as member of the interdisciplinary team, assesses and enters information pertinent to the patient’s medical record that is relevant to the patient’s medical, psycho-social and spiritual/religious goals of care. Gone are the days of paper documentation. The Chaplain must have computer skills. Documenting in the agency’s computer program, be it Solutions or Allscripts or another program, is simply an expectation. What is vital to the Chaplain is to memorialize not only the progress toward Outcomes, but also, observations of pain and decline. The Big MAC is a key element in observing decline. It is simple to use in concept and design. Please refer to my post published on 8/1/2014 for a review of the MAC. Standard 4, Teamwork and Collaboration: Team is an essential component of both hospice and palliative care, and the chaplain is a fully integrated member of the interdisciplinary team. The Chaplain has a seat at the table where patient issues are discussed. It is expected that the Chaplain will participate and function in a professional manner along with her colleagues. The Chaplain is expected to engage the IDT to provide support and encouragement. In my career it has been a privilege to conduct weddings, funerals, and other pastoral care support for my Teams. The influence a Chaplain can have on the IDT is invaluable. Standard 5, Ethical Practice: The chaplain will adhere to the Common Code of Ethics, which guides decision making and professional behavior. It is expected that the Chaplain holds the highest of ethical values and lives them out in his work. Standard 6, Confidentiality: The chaplain respects the confidentiality of information from all sources, including the patient/family members, medical record, interdisciplinary team members, larger health care team and local faith community members, in accordance with federal and state laws, regulations, and rules. HPPA guidelines are strict. Carelessness in handling confidential information could cost the Chaplain his/her position and include a hefty fine. Standard 7, Respect for Diversity: The chaplain models and collaborates with the organization and its interdisciplinary team in respecting and providing culturally, psycho-socially and spiritual/religiously competent patient- and family-centered care. The Chaplain is a leader in educating the IDT regarding other belief systems and how those beliefs impact the congregant at end of life. At Cornerstone Hospice, I provided education regarding “Caring for Jewish Hospice Patients” as part of our accreditation requirements. The study was embraced by the IDTs and by many other clinical staff that attended. In hospice care, a clinician for any discipline will engage patients from various ethnic, religious, and cultural backgrounds and do so without regard to those backgrounds. Time and again I have heard of the excellent care given to a patient and family and the theme is the same… “You treated us right.” It is hoped that as we progress through the Standards that we will recognize what great value the hospice Chaplain is to the IDT and the agency in total. There are high expectations, for certain, but look around, there are high expectations for the physicians, nurses, social workers, CNAs, volunteer specialist, and bereavement counselors. And, that is what makes hospice the great service that it is.

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