By Sr. Julie Houser, CSJ
Just today I was asked for a reference for a CPE student from 15 years ago. I remembered her as highly pastoral, very much a part of the group and sensitive in her visitation. I enthusiastically supported her application for her first chaplaincy position.
However, not long afterward, I considered the 15-year gap since her CPE training. Extensive changes have occurred during our center’s history, and the CPE curriculum has also advanced greatly. Queens Hospital Center has always been culturally, ethnically, and religiously diverse. We are also challenged to provide quality healthcare to the most indigent and sometimes sickest people in the country. The CPE program has needed to meet this challenge in its flexibility and its highly diverse mix of students.
Consequently, many of the changes in clinical pastoral education have followed changes in healthcare organization and delivery. This is the current challenge for life-sustaining identity. Hospital systems are challenged to create holistic treatment plans and partnerships in providing care from birth to death. Intense competition for patients has become the design and basis of a more holistic system of health and wellness care. Critical to this reorientation is the level of patient satisfaction, as measured by Press-Ganey evaluations.
Since spiritual care consistently improves patient satisfaction, the need for chaplains in all areas, even beyond the inpatient model, is rising. Knowing the design of healthcare organizations and the ability to meet patients’ spiritual needs is currently a very strong factor in funding pastoral care. The institution’s need for positive patient outcomes has skyrocketed the chaplains into a very effective and critical position. Furthermore, care is gradually moving from sickness to well care, spanning the generations. Chaplains must develop this flexibility of ministry from birth to death, from sickness to wellness. Good health practices are gaining ground in all city hospitals; we now have fresh vegetables and fruit sold from farm stands at each facility. Reaching out into the community, chaplains also need to relate to the hospital’s community advisory boards, thereby connecting with clergy of the area. For our chaplains, active involvement with the students in the mortuary, on site in each borough, raises awareness of the poor and unidentified bodies. Wake services and bereavement support are integral to the role of the chaplain.
Cultural, ethnic, and religious diversity necessities training and wholehearted efforts to meet the needs of patients and staff. Chaplains function on interdisciplinary teams and electronically chart on patients’ files, giving and responding to requests from the treatment team. Chaplains need not only familiarity with the Ethical and Religious Directives in Catholic healthcare, but also the knowledge of working through ethical decision-making with the ethics committee and prominent members of the treatment team. Changes in curriculum have enabled chaplains to meet the challenging new NACC competencies.
Curriculum for CPE must necessarily keep the students in sync with these changes and priorities. The contrast with the past CPE priorities and the present is amazing, and generally more and more inclusive of the chaplains into the main patient care model. System-dictated changes have included updates in technology, such as electronic charting, and many types of computer video communication and electronic meetings are available and common. Webinars and different forms of telecommunications are common and available. The CPE systems are also changed by hospital mergers, re-formation of systems, an expanded understanding of patients’ rights, and phone-based translators located at the end of the double telephone extension by each bed. Sensitivity and awareness of sexuality includes new terminology and options for acknowledging gender issues and sexual preference. Knowledge and sensitivity to religious beliefs and practices are more carefully delineated and needs met. Greater exposure to medical epidemics, greater knowledge and sensitivity to isolation-needed protocols and others are ever in flux.
And meanwhile, what about my former student? Like so many other certified chaplains who need to stay current, her pastoral skills and awareness could easily make the transition. As a very bright and highly pastoral professional, she would do well in bridging her CPE background and her professional practice to meet the current world of institutional pastoral care. She is the same gifted, unique, and creative person as she was in CPE. I would highly expect her to correctly evaluate her comfort and her skills and make the necessary changes. So will the rest of us.
I’m interested in the outcome of her employment interview.
Sr. Julie Houser, CSJ, is director and supervisor of the ACPE program in Queens Hospital Center, Jamaica, New York.
