1. Naming and Describing Services Chaplains Provide
Pre-conference Workshop March 11, 2006
NACC Columbus 2006
Rev. Dean V. Marek
Mayo Clinic, Rochester, MN
© Copyright by Mayo Clinic
ALL RIGHTS RESERVED
2006

2. 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!

3. “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.

4. A Question What are the services that only chaplains can provide?
What makes our contribution to the healthcare team unique?

5. The Work – Part I
Four published works describing chaplain services were distributed to 34 participants:
CARE Manual, Mayo Clinic, 1999
Spiritual Needs and Chaplaincy Services, Providence Health System, 2000
Professional Chaplaincy, Larry VandeCreek and Laurel Burton, 2001
Measures of Chaplain Performance and Productivity, Catholic Health Initiatives, 2002

6. Mayo Clinic, Rochester, MN
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

7. Service Types Direct AM Admit Home Visit Anointing Hospice Home Care
Anticipated Death Office Drop In
Bereavement Pastoral Contact
Care Conference Pre-surgical Contact
Code Public Worship
Crisis Care Research Intervention
Death Retreat Care Group
Ethics Consult Coordination Ritual/Sacrament
Ethics Consult Scheduled Spiritual Assessment
Ethics Contact Spiritual Care
Family Care Staff Care
Funeral/Wake Staff Care Group
Group Facilitation Staff Development/Teaching

8. Service Types Indirect
Administration Mission Support
CPE Administration Preparation Time
CPE Meeting Professional Organization
CPE Preceptorship Research
CPE Supervision Rounds
CPE Teaching Supervision
Meeting Volunteer Coordination

9. 2000

11. 2001

12. PROFESSIONAL CHAPLAINCY
Its Role and Importance In Healthcare Editors Larry VandeCreek D.Min. Laurel Burton Th.D. Design ZGroupinc NYC
2001

13. Chapter III
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.

14. 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

15. 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

16. 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 of 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

17. 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

18. 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

19. 2002

23. Digging Deeper What are the services that only chaplains can provide?
What makes our contribution to the healthcare team unique?

24. The Work - Part I In groups of four we:
examined the various published descriptions of services that chaplains provide
eliminated generic services, i.e., those services that other non-certified, non-chaplains can provide
agreed on those services that are unique to chaplains
wrote each service type on its own post-it note (51 service were noted)
collated the 51 notes into 16 unique categories

25. 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 -

26. 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

27. 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

28. 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

29. 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

30. 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.

31. 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.

32. 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

33. 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

34. 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

35. 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

36. 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

37. 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

38. 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

39. 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

40. 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.

41. 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

42. 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

43. 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

44. 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

45. 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

46. 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

47. 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

48. 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

49. 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)

50. 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

51. 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)

52. 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

53. 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.

54. Summary by Hits Advocacy Charting End of Life Care
13 Rituals
12 Education
6 Spiritual Assessment
6 Spiritual Intervention
4 Prayer/Meditation
3 Continuing Ed
2 Ethics Reflection
2 Theological Reflection
1 Each:
Advocacy
Charting
End of Life Care
Interpreting Religious Diversity
Ministry of Presence
Networking
Pastoral Presence
Religious Guidance

55. The Chaplain’s Tool Kit
What are the tools/skills that we bring with us when providing pastoral/spiritual care?

56. 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

57. 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

58. Continuing Education
Charting
Ethics Facilitation
Advocacy
Education
Theological Reflection
End of Life Care
Spiritual Intervention
COMPETENCIES
Interpret Religious Diversity
Spiritual Assessment
Ministry of Presence
Rituals
Religious Guidance
Prayer Meditation
Pastoral Presence
Networking

59. The Next Step
The pre-conference workshop participants will be asked by to review again the 16 categories and offer suggestions to further delineate (add or subtract) the services unique to chaplains

60. 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 at a later date

61. The Beginning