By David Lichter
T.S. Eliot in Little Gidding wrote, “For last year’s words belong to last year’s language. And next year’s words await another voice. And to make an end is to make a beginning.”
As we enter 2016, we leave the celebration of NACC’s 50th jubilee year, and the language of the theme: 50 years of honoring the gifts of our association, the depth of our theological roots, the richness of community, and our shared accountability for this profession. However, I believe the final words of that theme, our shared accountability for this profession, are apt words to express another voice for the beginning of 2016.
The main focus of this Vision issue is palliative care. Many of our authors this month are members who have successfully completed the new NACC specialty certification in palliative care and hospice. The development and implementation was guided by a commitment to our shared accountability for this profession. We are well aware of the developments in palliative care, particularly in improving the quality of spiritual care.
It is now seven years (hard to believe!) since February 2009, when a Consensus Conference took place in Pasadena, CA. The conference was based on the belief “that spiritual care is a fundamental component of quality palliative care.” Nearly 60 healthcare professionals gathered to come to consensus on spirituality “as it applies to health care and to make recommendations to advance the delivery of quality spiritual care in palliative care.”
Looking back, it is instructive that the five identified points of spiritual care practice included spiritual assessment; models of care and care plans; interprofessional team training; quality improvement; and personal and professional development. The first two are at the heart of the spiritual care competencies. One could make the case that the “interprofessional team training” and the vital role of the chaplain in that training is the frontier for chaplaincy “quality improvement” and “professional development” as we embrace our shared accountability for the profession.
The NACC palliative care and hospice implementation team focused resolutely on how to assess and strengthen chaplains’ competency, confidence, and comfort in being a coach and mentor for spiritual assessment and care to the other members of the interdisciplinary team. Tina Picchi, executive director of the Supportive Care Coalition (which will receive the 2016 NACC Outstanding Colleague Award), told me in 2012 that chaplains, while expert in assessment and care planning, often seemed to lack the confidence to coach that expertise in an interdisciplinary team setting. So we had the competence, but not the confidence and comfort.
Over the next two years, the NACC developed and implemented the palliative care and hospice specialty certification (as did our colleagues at the Association of Professional Chaplains). As one reads the procedures for applying for this advanced certification, one is immediately struck by the tone of the introduction that emphasizes the chaplain’s “personal and professional development” in his or her own spirituality, dealing with his or her own losses. Comfort and confidence grow out of one’s spiritual foundations, and strength and integrity are fruits of that foundation, as they need to be for all on the interdisciplinary team:
Palliative Medicine is a discipline that cultivates in each practitioner (nurse, physician, chaplain, social worker etc.) a servant’s heart and a sage’s mind. One’s effectiveness in this specialty can never be adequately assessed within a set of competencies and/or prescribed guidelines but rather in the human crucible of an integrated, interdisciplinary practice that draws equally from each one’s soulfulness as well as from each one’s skill and life experiences.
This specialty certification IS NOT about acquiring greater power or prestige, or mastering a particular set of skills/competencies or securing additional letters after one’s name, or
delivering a stellar performance at the time of the interview. This certification IS a special invitation for an individual candidate to go more deeply in one’s own spiritual life and to learn the way of the wounded healer – the way of authenticity, compassion, forgiveness, and healing. This disposition of mind and heart is cultivated from the inside out and flourishes in an environment where honesty, humility, and courage are in ample supply.
This focus guides the experience of the interdisciplinary certification interview team, which comprises two board certified chaplains and a palliative care clinician (physician or nurse practitioner):
The interview team will be interdisciplinary and will be specifically assessing the candidate for indications of one’s personal integration and ongoing formation, as demonstrated by:
• Major loss integration
• Self-awareness & understanding
• Human to human availability
• Understanding of relevant concepts
• Team collaboration, leadership and education contributions
The interview team will discern together each applicant’s desire and capability to be a leader/innovator in recognizing and fostering an Interdisciplinary Team’s (IDT) continuing
development in the areas of team respect, openness to new ideas and perspectives, and compassion for all involved in the palliative care/hospice arena.
This approach to assessing professional competencies goes beyond skills to the heart of what makes us whole in our humanity, what grounds and guides our comfort and confidence in the vital exchanges with the interdisciplinary team that let us become coaches and mentors in spirituality, which we not only know but live daily.
We are on this road together as we embrace “our shared accountability for this profession.”