I have read the Consensus Report and listened to the video. Some thoughts from the report:
1. It was overwhelming all that can be done. However, for a hospital with a small pastoral care department – we have two chaplains for 300 beds – it seems impossible to do all that is suggested. I like that it supports that “spiritual care is a fundamental component of quality palliative care.” We have always struggled in my hospital with palliative care being confused with end of life care, or hospice. I like that the consensus reports that “palliative care is viewed as applying to patients from the time of diagnosis of serious illness to death.” Let me just say that I have served on several committees within our system in the past five years to begin a more organized palliative care program. We had a nurse and SW leading it, but now it is just our SW. We are heading towards an APRN to join our SW and have a few docs already working in the hospital that are more palliatively inclined. We struggle with our oncology doctors to give a clear, honest outlook for our patients.
I like the definition of spirituality – “Spirituality is the aspect of humanity that refers to the way individuals seek and express meaning and purpose and the way they experience their connectedness to the moment, to self, to others, to nature, and to the significant or sacred.” That seems to cover it all, and this was written by an interdisciplinary group. The doctor I have worked most closely with is big on getting the patient story. Finding how to record that in the EHR is difficult. Like the consensus reports, “life is essentially relationship.” I do agree that getting the story is one of the key roles of the chaplain and then connecting that story to the treatment plan.
You asked about an instrument to guide the chaplain. Although I am board certified, I have not used an instrument in my own work. I do think the spiritual distress screening is good, but questionnaires that ask questions without interaction or exploration can become simply a box to tick off. I did like that the consensus recommended that “spirituality should be considered a patient vital sign.” Not sure how you get there, but I like that idea – like we do pain screenings regularly. I also hear that other disciplines can be involved in early screening but that the chaplain is the one to do the spiritual assessment. This is great if you can get other disciplines to comply. We have spiritual screening questions about stress, but they are not routinely asked. Only those who indicate severe levels of stress are referred, and I believe it should be high and severe. I am in a hospital system, so some departments are worried about having too many referrals. That is not the case at my hospital.
I agree that inter-professional rounds are great, but again when there are only two chaplains and rounds are long and not on a particular time schedule makes it difficult to participate. I also agree that professionals need care so as to not face compassion fatigue and burnout. At my hospital I have initiated a cart that is for staff. It roams around the hospital and includes massage therapy, aromatherapy, music, and some other stress relieving items. Staff love it when they come, but will often say “who has time for that.”
I also agree with the consensus that it is hard to accurately measure pastoral care. I think it has less to do with how satisfied patients are with their stay, although that is a good thing to show to administration. I think it is much deeper than that and am not sure how it could be measured. We have attempted to measure response to our Schwartz Rounds – another great staff support – and how often we are called when there is a death and our responsiveness to that. But overall I struggle with metrics and find myself more in the personal and spiritual world of patients.
The video was good but seemed more basic to me. I liked her four boxes for care – spiritual, physical, social, emotional. That is a good way to approach patients. As a current cancer patient myself, I would have to say that the spiritual, social, and emotional elements of my care have been missing from professionals. I go to a cancer center for my treatments and there is no support offered other than physical. I was told to check out a support group, but I lead the one at my hospital with our oncology nurse navigator and am not aware of any others in our city. I have good support from friends and family and church, but I am still struggling with things in each of these areas.
Enough for today. Will continue on with other lessons,