1. religion and spirituality

Naming and Describing
Services
Chaplains Provide
Pre-conference Workshop
March 11, 2006
NACC Columbus 2006
Rev. Dean V. Marek
Mayo Clinic, Rochester, MN
marek.dean@mayo.edu
•© Copyright by Mayo Clinic
•ALL RIGHTS RESERVED
•2006
Our Published Task
Attendees will develop a catalogue of
pastoral/spiritual care services to describe what
chaplains do. They will also author clear definitions
to explain the breadth and depth of the services we
provide. This catalogue may become a standard
reference for certifying organizations. This is a
working workshop!
“Chaplains are often exhausted by the
demands of their daily work, yet unable to
explain exactly what they do or how they
make a difference to patients or to their
organizations.”
Father Gerard Broccolo, Health Progress Magazine,
March-April 2004.
A Question
What are the services that only
chaplains can provide?
What makes our contribution to
the healthcare team unique?
The Work – Part I
Four published works describing chaplain services
were distributed to 34 participants:
1. CARE Manual, Mayo Clinic, 1999
2. Spiritual Needs and Chaplaincy Services,
Providence Health System, 2000
3. Professional Chaplaincy, Larry VandeCreek and
Laurel Burton, 2001
4. Measures of Chaplain Performance and Productivity,
Catholic Health Initiatives, 2002
CARE PROGRAM
(Chaplain Activity Record –
Electronic)
USERS MANUAL
Department of Chaplain Services
Mayo Clinic, Rochester, MN
June 10, 1999
Revised: April 26, 2001
July 16, 2004
November 12, 2004
May 31, 2005
1999
Service Types
Direct
AM Admit
Anointing
Anticipated Death
Bereavement
Care Conference
Code 45
Crisis Care
Death
Ethics Consult Coordination
Ethics Consult
Ethics Contact
Family Care
Funeral/Wake
Group Facilitation
Home Visit
Hospice Home Care
Office Drop In
Pastoral Contact
Pre-surgical Contact
Public Worship
Research Intervention
Retreat Care Group
Ritual/Sacrament
Scheduled Spiritual Assessment
Spiritual Care
Staff Care
Staff Care Group
Staff Development/Teaching
Service Types
Indirect
Administration
CPE Administration
CPE Meeting
CPE Preceptorship
CPE Supervision
CPE Teaching
Meeting
Mission Support
Preparation Time
Professional Organization
Research
Rounds
Supervision
Volunteer Coordination
2000
2001
PROFESSIONAL CHAPLAINCY
Its Role and Importance In Healthcare
Editors
Larry VandeCreek D.Min.
Laurel Burton Th.D.
Design
ZGroupinc NYC
2001
Chapter III
1. When religious beliefs and practices are tightly interwoven with
cultural contexts, chaplains constitute a powerful reminder of
the healing, sustaining, guiding, and reconciling power of
religious faith.
2. Professional chaplains reach across faith group boundaries and
do not proselytize. Acting on behalf of their institutions, they
also seek to protect patients from being confronted by other,
unwelcome, forms of spiritual intrusion.
3. They provide supportive spiritual care though empathic listening,
demonstrating an understanding of persons in distress. Typical activities
include:
• Grief and loss care
• Risk screening – identifying individuals whose religious/spiritual
conflicts may compromise recovery or satisfactory adjustment
• Facilitation of spiritual issues related to organ/tissue donation
• Crisis intervention/Critical Incident Stress Debriefing
• Spiritual assessment
• Communication with caregivers
• Facilitation of staff communication
• Conflict resolution among staff members, patients, and family members
• Referral and linkage to internal and external resources
• Assistance with decision making and communication regarding
decedent affairs
• Staff support relative to personal crises or work stress
• Institutional support during organizational change or crisis
4. Professional chaplains serve as members of patient care teams by:
• Participation in medical rounds and patient care conferences,
offering perspectives on the spiritual status of patients
• Participation in interdisciplinary education
• Charting spiritual care interventions in medical charts
5. Professional chaplains design and lead religious ceremonies of worship
and ritual such as:
• Prayer, meditation, and reading of holy texts
• Worship and observance of holy days
• Blessings and sacraments
• Memorial services and funerals
• Rituals at the time of birth or other significant times of life cycle
transition
• Holiday observances
6. Professional chaplains lead or participate in healthcare ethics programs by:
•
Assisting patients and families in completing advance directives
•
Clarifying value issues with patients, family members, staff and
the organization
•
Participating in Ethics Committees and Institutional Review Boards
•
Consulting with staff and patients about ethical concerns
•
Pointing to human value aspects of institutional policies and behaviors
•
Conducting in-service education
7. Professional chaplains educate the healthcare team and community regarding the relationship o
religious and spiritual issues to institutional services in the following ways: Interpreting and
analyzing multi-faith and multi-cultural traditions
as they impact clinical services
•
Making presentations concerning spirituality and health issues
•
Training of community religious representatives regarding the
institutional procedures for effective visitation
•
Training and supervising volunteers from religious communities who can
provide spiritual care to the sick
•
Conducting professional clinical education programs for
seminarians, clergy, and religious leaders
•
Developing congregational health ministries
•
Educating students in the healthcare professions regarding the
interface of religion and spirituality with medical care
8. Professional chaplains act as mediator and reconciler, functioning in the following ways for
those who need a voice in the healthcare system:
• As advocates or "cultural brokers" between institutions and patients,
family members, and staff
• Clarifying and interpreting institutional policies to patients,
community clergy, and religious organizations
• Offering patients, family members and staff an emotionally and spiritually "safe"
professional from whom they can seek counsel or guidance
• Representing community issues and concerns to the organization
9. Professional chaplains may serve as contact persons to arrange assessment for the
appropriateness and coordination of complementary therapies.
Patients increasingly demonstrate interest in healing from many sources not represented
within the traditional healthcare disciplines. Many of these complementary healing traditions
are grounded in the world’s religious traditions and chaplains may utilize or make a referral
for complementary therapies such as:
• Guided imagery/relaxation training
• Meditation
• Music therapy
• Healing touch
10. Professional chaplains and their certifying organizations encourage and
support research activities to assess the effectiveness of providing spiritual
care.
While many chaplains serve in settings with little interest in conducting
research, others are employed by centers with a research mission.
Increasingly, chaplains attend to research in the following ways:
• Developing spiritual assessment and spiritual risk screening tools
• Developing tools for benchmarking productivity and staffing
patterns that seek to increase patient and family satisfaction
• Conducting interdisciplinary research with investigators in allied
fields, publishing results in medical, psychological, and
chaplaincy journals
• Promoting research in spiritual care at national convention
2002
Digging Deeper
What are the services that only
chaplains can provide?
What makes our contribution to the
healthcare team unique?
The Work - Part I
In groups of four we:
1. examined the various published descriptions of
services that chaplains provide
2. eliminated generic services, i.e., those services that
other non-certified, non-chaplains can provide
3. agreed on those services that are unique to
chaplains
4. wrote each service type on its own post-it note (51
service were noted)
5. collated the 51 notes into 16 unique categories
Generic Services
There are some services that some chaplains provide
that other non-chaplains could well perform, thus
releasing the chaplain for those services that are
sui generis to the profession.
As it contained the most comprehensive listing of
chaplain activities, we looked again at Professional
Chaplaincy Chapter III to determine which
activities were unique to chaplains, i.e., what
services only chaplains could provide -
• Grief and loss care
• Risk screening – identifying individuals whose religious/spiritual
conflicts may compromise recovery or satisfactory adjustment
• Facilitate spiritual issues related to organ/tissue donation
• Crisis intervention/Critical Incident Stress Debriefing
• Spiritual assessment (some thought this is only the chaplain’s to do)
• Communication with caregivers
• Facilitate staff communication
• Conflict resolution among staff members, patients, and family
members
• Referral and linkage to internal and external resources
• Assist with decision making and communication regarding
decedent affairs
• Staff support relative to personal crises or work stress
• Institutional support during organizational change or crisis
• Participate in medical rounds and patient care conferences,
offering perspectives on the spiritual status of patients
• Participate in interdisciplinary education (if about religious issues)
• Chart spiritual care interventions in medical charts
• Assist patients and families in completing advance directives
• Clarify value issues with patients, family members, staff and
the organization
• Participate in Ethics Committees and Institutional Review Boards
• Consult with staff and patients about ethical concerns
• Point to human value aspects of institutional policies and
behaviors
• Conduct in-service ethics education
• Act as advocates or "cultural brokers" between institutions and
patients, family members, and staff
• Clarify and interpret institutional policies to patients,
community clergy, and religious organizations
• Offer patients, family members and staff an emotionally and
spiritually "safe" professional from whom they can seek counsel
or guidance
• Represent community issues and concerns to the organization
Chaplains may utilize or make a referral for complementary therapies
such as:
• Guided imagery/relaxation training
• Meditation
• Music therapy
• Healing touch
Chaplains attend to research in the following ways:
• Developing spiritual assessment and spiritual risk screening tools
• Developing tools for benchmarking productivity and staffing
patterns that seek to increase patient and family satisfaction
• Conducting interdisciplinary research with investigators in allied
fields, publishing results in medical, psychological, and chaplaincy
journals
• Promoting research in spiritual care at national convention
What’s Left?
The following services were considered
especially suited to chaplains because
of an implicit or explicit reference to
religion and/or spirituality and because
of the specific competencies necessary
to carry them out.
Chapter III
2. Professional chaplains reach across faith group
boundaries and do not proselytize. Acting on behalf
of their institutions, they also seek to protect patients
from being confronted by other, unwelcome, forms of
spiritual intrusion.
5. Professional chaplains design and lead religious
ceremonies of worship and ritual such as:
• Prayer, meditation, and reading of holy texts
• Worship and observance of holy days
• Blessings and sacraments
• Memorial services and funerals
• Rituals at the time of birth or other significant times
of life cycle transition
• Holiday observances
7. Professional chaplains educate the healthcare team and
community :
• Interpreting and analyzing multi-faith and multi-cultural
traditions as they impact clinical services
• Making presentations re: spirituality and health issues
• Training of community religious representatives regarding
the institutional procedures for effective visitation
• Training and supervising volunteers
• Conducting professional clinical education programs for
seminarians, clergy, and religious leaders
• Developing congregational health ministries
• Educating students in the healthcare professions regarding
the interface of religion and spirituality with medical care
The Work - Part II
After lunch dyads were formed and participants
were instructed to:
• chose one of the 16 categories and write a clear
concise description of the service
• name the skills/competencies necessary to
accomplish the service
• separate the service provided from the skills needed
to provide the service
The 16 Service Types
(In Alphabetical Order)
The number of “hits” associated with each
category represents the number of times the
service was mentioned in the Part I
1. Advocacy – 1 Hit
• Chaplains are a voice for the voiceless, vulnerable,
and persons at risk
• Editorial comment:
– Advocacy may be viewed as a skill to facilitate
appropriate services for patient care
2. Charting Spiritual Care – 1 Hit
• Record a clear and concise summary of the patient’s
spiritual concerns, how they have been addressed, and
the plan of care
• Communicate necessary information to the
interdisciplinary team
• Comment:
– Charting is an institutional imperative
– Bullet 2 would view it as communication for the
sake of collaboration, and thus indirect service for
patient care
3. Continuing Education – 3 Hits
• Professional development and maintenance of
credentials for ministry
• Comment:
– The writers wanted to see that the experience
gained in ministry would also be shared with
others
– This, then, would be categorized under
Education
4. Ethics Facilitation – 2 Hits
• Promote competent ethical reflection and
decision making
• Comment:
– May be viewed as a skill in service of the
patient
– May also be categorized as Spiritual Intervention
5. Education – 12 Hits
• Interpretation of the interface between spirituality
and health for the institution and community
• Comment:
– Recipients include patients, families, staff,
residents, students, parish nurses, congregational
health ministries, volunteers, etc.
– Venues include employee orientation, CPE,
continuing education, churches, Pastoral Care
Week, etc.
6. End of Life Care – 1 Hit
• Pastoral care at the time of loss, grave or terminal
diagnosis, withdrawal of life support, fetal demise,
and sudden death
• Comment:
– This may be categorized as Spiritual Intervention
– However, EOL Care it may stand on its own as a
major ministry in Hospice and because of the
nature of the population we serve
7. Interpret Religious Diversity and
Spiritual Practices – 1 Hit
• Interpret the spiritual/religious teachings and
practices of a diverse patient population as they
impact an individual need
• Comment:
– This is a skill that may be part of a Spiritual
Intervention
– It is Education in that it informs staff of
unfamiliar religious practices
8. Ministry of Presence – 1 Hit
• Assist those served to access their spirituality as
part of the healing process
• Comment:
– The ministry of presence may encompass a
variety of skills that are invoked by the chaplain
to release the spiritual power of the patient and
facilitate the healing process
– It is a skill set in the chaplain’s tool kit
9. Networking – 1 Hit
• Connect community faith resources to particular
patient spiritual needs
• Comment:
– Networking is a process that results in
collaboration for patient care
– As such it is an indirect service that facilitates a
Spiritual Intervention
10. Pastoral Presence – 1 Hit
• Ministry to a patient from an initial meeting with a
spiritual assessment through appropriate spiritual
interventions , follow-up ministry, and dismissal
• Comment:
– Pastoral presence, similar to the ministry of
presence, encompasses a variety of spiritual
interventions that are facilitated by the chaplain
to release the spiritual power of the patient
– It is an attitude more than a specific service
11. Prayer and Meditation – 4 Hits
• Attention to the patient’s condition reflecting the
concerns of the patient providing comfort and
reassurance
• Comment:
– Prayer is often viewed as something done by the
chaplain for the patient, “I’ll pray for you,” rather
than a sacred/spiritual dialogue that facilitates the
patient’s journey to his/her soul wherein lies the
primary source of spiritual power
– Prayer is a tool in the chaplain’s kit that may or may
not be a part of every Spiritual Intervention
12. Religious and Moral
Guidance - 1 Hit
• Caring for the soul of the institution, the
chaplain provides religious and moral guidance
to the system, administration, employees, and
medical staff
• Comment:
– The chaplain is a facilitator of spiritual care.
This category may better be included under
Spiritual Intervention
13. Rituals – 13 Hits
• Celebration of symbolic acts of the community of
faith, which provide meaning to the experience of
illness, suffering, and loss
• Comment:
– The number of hits would indicate that ritual
practices are a large part of the services chaplains
provide
– See next slide for an enumeration of services
mentioned
13. Rituals – 13 Hits
•
•
•
•
•
•
•
Anointing with oil
Blessings
Creating situation specific rituals (2x)
Leading reflections
Memorial services (x2)
Religious services
Rituals at birth and other significant
times
• Sacraments
• Worship services (x3)
14. Spiritual/Religious
Assessment - 6 Hits
• Discern and understand patients’ spiritual needs and
concerns in light of their current health issues
• Comment:
– A chaplain’s spiritual assessment is often done
informally in hospital, given the short length of
stay, and informs all spiritual interventions at the
point of delivery
– All participants believe that the professional
chaplain is most qualified to make an accurate
spiritual assessment
15. Spiritual Intervention – 6 Hits
• Response of the community of faith to the assessed
spiritual needs and concerns of the patient to find
meaning in the experience of illness and facilitate
the process of spiritual healing
• Comment:
– It is evident that several of the services already
mentioned would better fit in this category
– A more suitable term than intervention might be
chosen to highlight the sacred nature of our care
(cura animarum – care of souls)
15. Spiritual Interventions (Care)
•
•
•
•
•
•
•
•
•
Crisis Care
Life Review
Sacred Stories
Support
Sp. Counsel/Direction
Advocacy
End of Life Care
Ethics Consult
Interpret Rel Diversity and
Practice
• Networking
• Prayer/Meditation
• Religious/Moral Guidance
• Spiritual Assessment
• Theological Reflection
• Rituals
Not mentioned:
• Bereavement Care
• Family Care
• Staff Care
16. Theological Reflection Sensitivity to Diversity – 2 Hits
• Facilitates a patient’s ability in bringing faith to his or
her current experience
• Comment:
– This, too, may be a Spiritual Intervention, as the
chaplain facilitates the “spiritual work” of the
patient.
Summary by Hits
1 Each:
1. 13 Rituals
2. 12 Education
3. 6 Spiritual Assessment
4. 6 Spiritual Intervention
5. 4 Prayer/Meditation
6. 3 Continuing Ed
7. 2 Ethics Reflection
8. 2 Theological Reflection
•
•
•
•
•
•
•
•
Advocacy
Charting
End of Life Care
Interpreting Religious
Diversity
Ministry of Presence
Networking
Pastoral Presence
Religious Guidance
The Chaplain’s Tool Kit
What are the tools/skills that we bring with
us when providing pastoral/spiritual care?
Tools/Skills
•
•
•
•
•
•
•
•
•
•
•
•
Non-anxious Presence
Non-judgmental Acceptance
Respect for Diversity
Solidarity with the Vulnerable
Ability to Listen
Compassion
Empathy
Self-awareness
Developed Intuition
Professional Boundaries
Relational/Comm Skills
Comfort with Silence
•
•
•
•
•
•
•
•
•
•
•
•
Gift of Time
Theological Education
Ability to Reflect Theologically
Spiritual Knowledge
Religious Knowledge
Shared Spiritual Power
Denominational Endorsement
Pastoral Authority
Prayer, Rituals, and Sacraments
Discernment
Self Esteem
Ability to Assess Spiritually
The Work - Part II
•
•
•
We also examined the NACC competencies for
certification to name any that are generic
The group agreed that the competencies must remain
intact as the necessary heart and foundation for all
chaplain services
• Personal
• Theological
• Professional
No one category could stand alone as more
important than the others
Charting
Continuing
Education
Advocacy
Education
Theological
Reflection
Spiritual
Intervention
End of Life
Care
COMPETENCIES
Spiritual
Assessment
Interpret
Religious
Diversity
Ministry of
Presence
Rituals
Religious
Guidance
Ethics
Facilitation
Prayer
Meditation
Pastoral
Presence
Networking
The Next Step
• The pre-conference workshop participants
will be asked by email to review again the 16
categories and offer suggestions to further
delineate (add or subtract) the services unique
to chaplains
The Afternoon Session
• Participants were asked to name for themselves
those services that were unique to a chaplain by
reason of profession and competencies
• Results were shared at each table
• Each table agreed upon one list of services as
unique to chaplains
• The results will be collated and compared with
the work of the pre-conference workshop and
posted on www.nacc.org at a later date
The Beginning