By Gordon J. Hilsman, DMin, BCC
Standard 1. Assessment: The chaplain gathers and evaluates relevant data pertinent to the patient’s situation and/or bio-psycho-social-spiritual/religious health.
Three essential components hold up quality assessment like the proverbial three-legged stool: 1) a profound reverence for the process of assessment; 2) competence in establishing rapport; and 3) a conceptual framework for understanding and communicating issues that affect holistic well-being. Assessment fails to find much usefulness when any of them is missing.
1. Reverence: Every spiritual assessment is a work of art and needs to be approached with the utmost reverence. Anybody seeking to appraise your financial situation would be immediately suspected. Assessing a person’s spirit and soul is far more intricate and intimate. Nobody ought to encroach on that territory without constant self-vigilance against distractions, interface issues, and impulses to trivialize and generalize from inattention or fatigue. Assessment is sacred ground.
2. Rapport: The etymology of the word “assessment” combines the Latin prefix ad meaning “next to,” and sedere meaning “to sit.” “Assess” means “to sit beside.” Unless you’re willing and able to sit beside someone in personal listening, rather than diagnostic listening, to hear him or her deeply to establish the elusive interpersonal trusting engagement called rapport, your assessment will be superficial at best and spiritually brutal at worst.Learning to establish rapport with as wide a diversity of people as possible is much of the goal of formative Clinical Pastoral Education. Refining such fundamental skills as lingering, gentle query, reflecting emotion, supportive validating, astute interpretation, attention to detail, minimal self-disclosure, and prescriptive physical touch constitutes the primary work of maintaining quality chaplaincy practice. Assessment quality largely depends on rapport, with patient, family members and interdisciplinary staff.
3. Conceptual Framework: In order for a spiritual caregiver to find the best direction for her care in any given pastoral situation she constantly invests in shaping and deepening a concise and useable framework of concepts with which to communicate assessments. The highly complex data of spiritual assessment, from the subject’s physical situation, current cognition, human relationships and ways of coping with and enjoying Transcendence, need a lively intuitive assimilation to make assessment useable to interdisciplinary teams.
A brief description of one conceptual framework developed and used for six years by a West Coast Franciscan spiritual care department can exemplify how a chaplaincy team can function together in providing spiritual assessment as a valued part of interdisciplinary staffing throughout a healthcare system.
Four questions guide this unique multi-faceted assessment. The questions themselves are not asked of people. They prompt identifying issues from careful listening, along four axes: emotional support, major loss, religious/spiritual care, and referral concerns. The framework is sparse enough to allow considerable unique description by very different chaplains, and full enough to broadly apply to many common spiritual issues of hospitalized people, their families and care of the staff who attend to them. The questions are:
Each question opens the chaplain’s thinking to five or six specific spiritual needs. Twenty-one identified chaplain functions have been designed by the staff to address the 21 needs that result. The staff also collaborated on describing several spiritual care outcomes that an experienced chaplain is likely to hope for when engaging in any of the functions.
Standard 2. Delivery of Care: The chaplain develops and implements a plan of care to promote patient well-being and continuity of care.
This standard requires fashioning a spiritual care strategy, answering succinctly, “What will the chaplain do to meet the identified needs of this patient or family?”
Care plans can be some of the most difficult aspects of reporting for chaplains. Before about the year 2000, CPE didn’t prepare ministers well for articulating either assessments or plans. Some brief, human-oriented chart writing, however, helps to preserve and promote interdisciplinary teams’ impressions of patients and families as real people in the sometimes sterile and strident healthcare arena.
An assessment and plan together blend the color of human description with the brevity of clinical communication. An imaginative narrative conveys the humanness of a patient and situation, while summary points (previously called “bullet points”) summarize issues and plans to be easily grasped by busy MDs and RNs. Fashioning no more than two or three summary points constitutes an art all its own.
Summary points flow naturally from identified spiritual needs. Any of the five categories of major loss needs (at Franciscan Health System, Tacoma, WA, these are recent, previous, major adjustment, dying, and estrangement) suggest a grief care summary point.
Emotional support needs (stabilizing, verbal processing, empowering, waiting/networking, and informing/interpreting) suggest summary points about caring for the patient’s unique and problematic emotions of sadness, anger, hurt, fear, or guilt/shame.
Referral issue needs (medical ethics, addiction/mental illness assessment, advocacy, or love/life pain) indicate a summary point on engaging in a quality, motivating referral process, preferably naming the caregiver the chaplain suggests is needed for further care of identified issues.
Each spiritual and religious need (FHS names religious support, spiritual support, spiritual counseling, facilitating self-forgiveness, and instructing) may call for a summary point on what the chaplain did and intends to do regarding the person’s current religious or spiritual struggle.
If a chaplain can’t identify any plans that fit the patient’s situation, she documents that common eventuality so that staff members know she saw no need for follow-up.
NACC and ACPE Supervisor Gordon J. Hilsman will speak on this process in June at a four-hour pre-conference workshop titled “Summary Point Charting for Interdisciplinary Effectiveness” at the APC annual meeting in Schaumberg, IL. Graphics and descriptions of the assessment process outlined here can be obtained from St. Joseph Medical Center, Tacoma, WA, or by contacting Hilsman at firstname.lastname@example.org.
Read the next article in this series:
Standard 3: Charting can allow meaningful stories to shape patient care
Comment on this article