By Linda F. Piotrowski
It seems to me that when we chaplains long for interdisciplinary care, we’re not really sure what we are longing for. When I participated in the ACE Project (a National Cancer Institute transdisciplinary palliative care education program) designed to serve psycho-social-spiritual professionals, we were asked to reflect up-on what we believed about ourselves as professionals.
The ACE Project team issued a challenge in the form of a moral imperative: Each of us was accountable for creating meaningful change on behalf of the vulnerable populations that we served. That meaningful change was to include advocating and working not for interdisciplinary care but for transdisciplinary care.
The following might be helpful in defining terms and helping to decide where we are located in our ministry, as well as what would help our patients/residents and their loved ones:
Traditional Multidisciplinary Practice
(Typically a reactive, physician-led model with ad hoc membership using a consultative format.)
Interdisciplinary Team
(More “proactive” model; theoretically recognizes contributions of all, but is typically MD-RN-based and physician-led.)
Transdisciplinary Team
(Systems theory; shared team vision; recognized role overlap, inte-grated responsibilities, training, leadership, and decision-making.)
ACE Project, 2007
Multidisciplinary, interdisciplinary or transdisciplinary? Palliative care and hospice have an ideal setting for developing team practice. Meetings of as many healthcare providers as possible are scheduled regularly. All team members are expected to contribute from their area of expertise.
However, reimbursement for services, scheduling, patient volumes, etc., all con-tribute to the failure to create space for team meetings, which are considered a luxury. If you are not within a setting that provides you the opportunity to be a part of an interdisciplinary or transdisciplinary care team, do you just throw up your hands and give up?
I do not believe that interdisciplinary or transdisciplinary care happens only when the disciplines involved in the care have regular team meeting. I believe it happens when we join with other disciplines to provide care that addresses the patient’s complex needs.
How can you influence patient care in a positive and collaborative way? The first step is to assess yourself and your own practice.
Ask yourself:
- Am I a professional healthcare clinician?
- Am I committed to lifelong learning, increasing my knowledge and professional skills?
- Do I team up with other members of the healthcare team?
- Do I advocate for change?
- Do I use the results of research to inform my practice?
- Do I know basic principles of pain and symptom management?
- Is spiritual assessment and documentation a part of my practice?
- How intentional am I about communicating my spiritual assessment, care planning, and documentation with the team?
- Do I address the multidimensional aspects of suffering?
- Do I advocate for families using spiritually and culturally relevant rituals in the healthcare setting?
- Do I manage the personal and professional impact of chronic compassion fatigue in myself and others?
What other aspects of care, professional development and engagement do you need to assess in order to improve?
Once your self-assessment is complete, you are ready to develop a plan for engaging with others in your setting in order to provide the best care possible. One way to do this is to choose one area where you want to step out of your comfort zone in order to improve your practice. Use the S.M.A.R.T system of goal setting.
Creating a culture of interdisciplinary/transdisciplinary care does not require a regular meeting schedule. S.M.A.R.T. goals can assist in initiating change. Find a mentor and someone from one or two other disciplines to engage with you in your effort.
Reach out to doctors, nurses, social workers, therapists, and volunteers to work on a patient care project. Each time we join together with another healthcare professional, we demonstrate our credibility as well as cultivate our own confidence in our competence as clinicians, researchers, and advocates. Before you know it interdisciplinary/transdisciplinary care will become a part of your institution’s culture of care.
Linda F. Piotrowski, BCC, is a retired palliative care chaplain at Dartmouth Hitchcock Medical Center in Lebanon, N.H.
Suggested resources
Larson, D. (1993), The helper’s journey: Working with people facing grief, love, and life-threatening illness. Champaign, IL, Research Press.
Module 1, Notes from Moral Imperative to Improve Palliative Care, ACE Project, City of Hope, 2007.
Piotrowski, L. (2011) Chapter 7, “A Transdisciplinary Approach to Spiritual Care” in Spirituality and End-of Life Care, part of the “Living with Grief” series published by the Hospital Foundation of America, edited by Kenneth J. Doka and Amy S. Tucci.
Piotrowski, L. (2011) Chapter 50, “Teamwork in Palliative Care: Social Work Role with Spiritual Care Professionals” in the Oxford Textbook of Palliative Social Work, edited by Terry Altilio and Shirley Otis Green, Oxford University Press.
Piotrowski, L. (2012) Chapter 18, Transdisciplinary Relationships in Professional Spiritual & Pastoral Care: A Practical Clergy and Chaplain’s Handbook edited by Rabbi Stephen B. Roberts, Skylight Paths Publishing.
