By Gordon J. Hilsman
The quiet dispute over whether chaplains could beneficially learn to use narratives in their charting notes emanates at least partly from some spiritual caregivers’ difficulty in imagining patient situations in story form. As a partial remedy, consider these seven kinds of stories that hospitalized people often experience and share with chaplains and other caregivers. When shared in medical record notes with interdisciplinary team members, any one of these stories might foster greater team awareness of spiritual needs, and of the healing that can take place around them.
The story of hospitalization: Some stories of the very process of how this person became hospitalized remain unknown to some IDT members. When there are colorful aspects that are shared in brief detail in a chart note, the patient becomes more boldly visible to those who read the note. That patient becomes more uniquely human to IDT members, enriching a bit the interpersonal culture of hospital care.
The story of the reason for hospitalization: People tend to share how their serious condition occurred or developed over time. They may do this more fully with a chaplain who lingers with them in dedicated listening than with busy clinicians. What is unique about any of these stories, and what seems to be the particular focus of the person as she tells it, may be quite significant data for both nurses and medical practitioners.
The story of attitude: A person’s feelings about his condition and its treatment are likely to be of particular interest to physicians. This was true even before “the patient experience” and patient satisfaction became an additional motivation for careful medical practice. Many doctors know that attitude toward one’s medical condition affects healing, although how is not yet well understood.
Stories of medical events: The simple story of how a person reacted to recent events in her medical saga is likely to also be of interest to the professionals caring for that person. Changes in attitude, motivation, or decision-making, perhaps illustrated by a patient quote, may be of particular use to treatment team members.
Stories of family events: What is happening of either joy or worry in the lives of one’s family members can suggest a succinct story, in one sentence or less, that paints a picture of this person as real and striving for bits of happiness — warmth, love, pride, relief, hopes, or resolutions — wherever they can be found.
Stories of regrets: The “mother of all spiritual needs” is still regret — in the forms of guilt, shame, hurt, or regret over what one has done or endured that continues to return unpleasantly to consciousness even years later. Writing down people’s stories of regret, whether remorseful confession or humiliating abuse, can be intricate as a chaplain scampers along the line of confidentiality. But if that chaplain wants to be part of the umbrella of confidentiality under which IDTs function, she must contribute to it as well. Finding general terms with which to record these as significant spiritual events in this person’s life further solidifies team members’ awareness of how complex personal healing can be.
Stories of brushes with transcendence: Experiences of awe on the one hand, and dread at impending tragedy on the other, shape one’s very spirituality. They etch themselves into our memories and influence our attitudes toward the unmanageable and unfathomable aspects of human experience. Hospitalization seems to precipitate both the experiences themselves and sharing them with a relatively objective person dedicated to the care of people’s spirit. Stories in well-chosen words that convey the profundity of such experiences to caregivers remind those professionals of the value of their own work. Such stories also are likely to increase their professional satisfaction.
Hyper-verbal accounts of what has transpired between patient and chaplain quickly become burdensome to clinical practitioners. But summary sentences, succinctly conveying the current state of the human spirit of that person, hit home in the hearts of IDT members. Fashioning narrative chart notes that achieve that end remains an art and probably always will. It is an art worth developing.
Gordon J. Hilsman, BCC-S, is a retired ACPE/NACC Supervisor living in Fircrest, WA.