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Naming and Describing Services Chaplains Provide Rev. Dean V. Marek Mayo Clinic, Rochester, MN NACC Columbus 2006.

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Presentation on theme: "Naming and Describing Services Chaplains Provide Rev. Dean V. Marek Mayo Clinic, Rochester, MN NACC Columbus 2006."— Presentation transcript:

1 Naming and Describing Services Chaplains Provide Rev. Dean V. Marek Mayo Clinic, Rochester, MN marek.dean@mayo.edu marek.dean@mayo.edu NACC Columbus 2006 Pre-conference Workshop March 11, 2006 © Copyright by Mayo Clinic© Copyright by Mayo Clinic ALL RIGHTS RESERVEDALL RIGHTS RESERVED 20062006

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? 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: 1.CARE Manual, Mayo Clinic, 1999 2.Spiritual Needs and Chaplaincy Services, Providence Health System, 2000 3.Professional Chaplaincy, 3.Professional Chaplaincy, Larry VandeCreek and Laurel Burton, 2001 4.Measures of Chaplain Performance and Productivity, Catholic Health Initiatives, 2002

6 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 45 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 AdministrationMission Support CPE AdministrationPreparation Time CPE MeetingProfessional Organization CPE PreceptorshipResearch CPE SupervisionRounds CPE TeachingSupervision MeetingVolunteer Coordination

9 2000

10

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 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.

14 3. They provide supportive spiritual care though empathic listening, demonstrating an understanding of persons in distress. Typical activities include: Grief and loss careGrief and loss care Risk screening – identifying individuals whose religious/spiritual conflicts may compromise recovery or satisfactory adjustmentRisk screening – identifying individuals whose religious/spiritual conflicts may compromise recovery or satisfactory adjustment Facilitation of spiritual issues related to organ/tissue donationFacilitation of spiritual issues related to organ/tissue donation Crisis intervention/Critical Incident Stress DebriefingCrisis intervention/Critical Incident Stress Debriefing Spiritual assessmentSpiritual assessment Communication with caregiversCommunication with caregivers Facilitation of staff communicationFacilitation of staff communication Conflict resolution among staff members, patients, and family membersConflict resolution among staff members, patients, and family members Referral and linkage to internal and external resourcesReferral and linkage to internal and external resources Assistance with decision making and communication regarding decedent affairsAssistance with decision making and communication regarding decedent affairs Staff support relative to personal crises or work stressStaff support relative to personal crises or work stress Institutional support during organizational change or crisisInstitutional 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 patientsParticipation in medical rounds and patient care conferences, offering perspectives on the spiritual status of patients Participation in interdisciplinary educationParticipation in interdisciplinary education Charting spiritual care interventions in medical chartsCharting 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 textsPrayer, meditation, and reading of holy texts Worship and observance of holy daysWorship and observance of holy days Blessings and sacramentsBlessings and sacraments Memorial services and funeralsMemorial services and funerals Rituals at the time of birth or other significant times of life cycle transitionRituals at the time of birth or other significant times of life cycle transition Holiday observancesHoliday observances

16 6. Professional chaplains lead or participate in healthcare ethics programs by: Assisting patients and families in completing advance directives Assisting patients and families in completing advance directives Clarifying value issues with patients, family members, staff and the organization Clarifying value issues with patients, family members, staff and the organization Participating in Ethics Committees and Institutional Review Boards Participating in Ethics Committees and Institutional Review Boards Consulting with staff and patients about ethical concerns Consulting with staff and patients about ethical concerns Pointing to human value aspects of institutional policies and behaviors Pointing to human value aspects of institutional policies and behaviors Conducting in-service education 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 Making presentations concerning spirituality and health issues Training of community religious representatives regarding the institutional procedures for effective visitation 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 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 Conducting professional clinical education programs for seminarians, clergy, and religious leaders Developing congregational health ministries Developing congregational health ministries Educating students in the healthcare professions regarding the interface of religion and spirituality with medical care 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 staffAs advocates or "cultural brokers" between institutions and patients, family members, and staff Clarifying and interpreting institutional policies to patients, community clergy, and religious organizationsClarifying 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 guidanceOffering 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 organizationRepresenting 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 worlds religious traditions and chaplains may utilize or make a referral for complementary therapies such as: Guided imagery/relaxation trainingGuided imagery/relaxation training MeditationMeditation Music therapyMusic therapy Healing touchHealing 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 toolsDeveloping spiritual assessment and spiritual risk screening tools Developing tools for benchmarking productivity and staffing patterns that seek to increase patient and family satisfactionDeveloping 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 journalsConducting interdisciplinary research with investigators in allied fields, publishing results in medical, psychological, and chaplaincy journals Promoting research in spiritual care at national conventionPromoting research in spiritual care at national convention

19 2002

20

21

22

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

24 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

25 Generic Services 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 - 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.

26 Grief and loss careGrief and loss care Risk screening – identifying individuals whose religious/spiritual conflicts may compromise recovery or satisfactory adjustmentRisk screening – identifying individuals whose religious/spiritual conflicts may compromise recovery or satisfactory adjustment Facilitate spiritual issues related to organ/tissue donationFacilitate spiritual issues related to organ/tissue donation Crisis intervention/Critical Incident Stress DebriefingCrisis intervention/Critical Incident Stress Debriefing Spiritual assessment (some thought this is only the chaplains to do)Spiritual assessment (some thought this is only the chaplains to do) Communication with caregiversCommunication with caregivers Facilitate staff communicationFacilitate staff communication Conflict resolution among staff members, patients, and family membersConflict resolution among staff members, patients, and family members Referral and linkage to internal and external resourcesReferral and linkage to internal and external resources Assist with decision making and communication regarding decedent affairsAssist with decision making and communication regarding decedent affairs Staff support relative to personal crises or work stressStaff support relative to personal crises or work stress Institutional support during organizational change or crisisInstitutional support during organizational change or crisis

27 Participate in medical rounds and patient care conferences, offering perspectives on the spiritual status of patientsParticipate in medical rounds and patient care conferences, offering perspectives on the spiritual status of patients Participate in interdisciplinary education (if about religious issues)Participate in interdisciplinary education (if about religious issues) Chart spiritual care interventions in medical chartsChart spiritual care interventions in medical charts Assist patients and families in completing advance directivesAssist patients and families in completing advance directives Clarify value issues with patients, family members, staff and the organizationClarify value issues with patients, family members, staff and the organization Participate in Ethics Committees and Institutional Review BoardsParticipate in Ethics Committees and Institutional Review Boards Consult with staff and patients about ethical concernsConsult with staff and patients about ethical concerns Point to human value aspects of institutional policies and behaviorsPoint to human value aspects of institutional policies and behaviors Conduct in-service ethics educationConduct in-service ethics education

28 Act as advocates or "cultural brokers" between institutions and patients, family members, and staffAct as advocates or "cultural brokers" between institutions and patients, family members, and staff Clarify and interpret institutional policies to patients, community clergy, and religious organizationsClarify 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 guidanceOffer 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 organizationRepresent community issues and concerns to the organization Chaplains may utilize or make a referral for complementary therapies such as: Guided imagery/relaxation trainingGuided imagery/relaxation training MeditationMeditation Music therapyMusic therapy Healing touchHealing touch

29 Chaplains attend to research in the following ways: Developing spiritual assessment and spiritual risk screening toolsDeveloping spiritual assessment and spiritual risk screening tools Developing tools for benchmarking productivity and staffing patterns that seek to increase patient and family satisfactionDeveloping 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 journalsConducting interdisciplinary research with investigators in allied fields, publishing results in medical, psychological, and chaplaincy journals Promoting research in spiritual care at national conventionPromoting research in spiritual care at national convention

30 Whats 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 textsPrayer, meditation, and reading of holy texts Worship and observance of holy daysWorship and observance of holy days Blessings and sacramentsBlessings and sacraments Memorial services and funeralsMemorial services and funerals Rituals at the time of birth or other significant times of life cycle transitionRituals at the time of birth or other significant times of life cycle transition Holiday observancesHoliday observances

33 7. Professional chaplains educate the healthcare team and community : Interpreting and analyzing multi-faith and multi-cultural traditions as they impact clinical servicesInterpreting and analyzing multi-faith and multi-cultural traditions as they impact clinical services Making presentations re: spirituality and health issuesMaking presentations re: spirituality and health issues Training of community religious representatives regarding the institutional procedures for effective visitationTraining of community religious representatives regarding the institutional procedures for effective visitation Training and supervising volunteersTraining and supervising volunteers Conducting professional clinical education programs for seminarians, clergy, and religious leadersConducting professional clinical education programs for seminarians, clergy, and religious leaders Developing congregational health ministriesDeveloping congregational health ministries Educating students in the healthcare professions regarding the interface of religion and spirituality with medical careEducating 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 servicechose one of the 16 categories and write a clear concise description of the service name the skills/competencies necessary to accomplish the servicename the skills/competencies necessary to accomplish the service separate the service provided from the skills needed to provide the serviceseparate 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 riskChaplains are a voice for the voiceless, vulnerable, and persons at risk Editorial comment: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 patients spiritual concerns, how they have been addressed, and the plan of careRecord a clear and concise summary of the patients spiritual concerns, how they have been addressed, and the plan of care Communicate necessary information to the interdisciplinary teamCommunicate necessary information to the interdisciplinary team Comment: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 ministryProfessional development and maintenance of credentials for ministry Comment: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 makingPromote competent ethical reflection and decision making Comment: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 communityInterpretation of the interface between spirituality and health for the institution and community Comment: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 deathPastoral care at the time of loss, grave or terminal diagnosis, withdrawal of life support, fetal demise, and sudden death Comment: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 needInterpret the spiritual/religious teachings and practices of a diverse patient population as they impact an individual need Comment: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 processAssist those served to access their spirituality as part of the healing process Comment: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 chaplains tool kit

44 9. Networking – 1 Hit Connect community faith resources to particular patient spiritual needsConnect community faith resources to particular patient spiritual needs Comment: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 dismissalMinistry to a patient from an initial meeting with a spiritual assessment through appropriate spiritual interventions, follow-up ministry, and dismissal Comment: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 patients condition reflecting the concerns of the patient providing comfort and reassuranceAttention to the patients condition reflecting the concerns of the patient providing comfort and reassurance Comment:Comment: –Prayer is often viewed as something done by the chaplain for the patient, Ill pray for you, rather than a sacred/spiritual dialogue that facilitates the patients journey to his/her soul wherein lies the primary source of spiritual power –Prayer is a tool in the chaplains 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 staffCaring for the soul of the institution, the chaplain provides religious and moral guidance to the system, administration, employees, and medical staff Comment: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 lossCelebration of symbolic acts of the community of faith, which provide meaning to the experience of illness, suffering, and loss Comment: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 oilAnointing with oil BlessingsBlessings Creating situation specific rituals (2x)Creating situation specific rituals (2x) Leading reflectionsLeading reflections Memorial services (x2)Memorial services (x2) Religious servicesReligious services Rituals at birth and other significant timesRituals at birth and other significant times SacramentsSacraments Worship services (x3)Worship services (x3)

50 14. Spiritual/Religious Assessment - 6 Hits Discern and understand patients spiritual needs and concerns in light of their current health issuesDiscern and understand patients spiritual needs and concerns in light of their current health issues Comment:Comment: –A chaplains 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 healingResponse 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: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 patients ability in bringing faith to his or her current experienceFacilitates a patients ability in bringing faith to his or her current experience Comment:Comment: –This, too, may be a Spiritual Intervention, as the chaplain facilitates the spiritual work of the patient.

54 Summary by Hits 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 1 Each: Advocacy Charting End of Life Care Interpreting Religious Diversity Ministry of Presence Networking Pastoral Presence Religious Guidance

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

56 Tools/Skills Non-anxious PresenceNon-anxious Presence Non-judgmental AcceptanceNon-judgmental Acceptance Respect for DiversityRespect for Diversity Solidarity with the VulnerableSolidarity with the Vulnerable Ability to ListenAbility to Listen CompassionCompassion EmpathyEmpathy Self-awarenessSelf-awareness Developed IntuitionDeveloped Intuition Professional BoundariesProfessional Boundaries Relational/Comm SkillsRelational/Comm Skills Comfort with SilenceComfort 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 genericWe 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 servicesThe group agreed that the competencies must remain intact as the necessary heart and foundation for all chaplain services PersonalPersonal TheologicalTheological ProfessionalProfessional No one category could stand alone as more important than the othersNo one category could stand alone as more important than the others

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

59 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 chaplainsThe 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

60 The Afternoon Session Participants were asked to name for themselves those services that were unique to a chaplain by reason of profession and competenciesParticipants 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 tableResults were shared at each table Each table agreed upon one list of services as unique to chaplainsEach 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 dateThe results will be collated and compared with the work of the pre-conference workshop and posted on www.nacc.org at a later datewww.nacc.org

61 The Beginning


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