Charting Spiritual Care: The Emerging Role of Chaplaincy Records in Global Health Care

ISBN-13: 9783030470692 / Angielski / Twarda / 2020 / 232 str.

Simon Peng-Keller; David Neuhold

Spis treści

Simon Peng-Keller/David Neuhold 

Recording spiritual care in electronic medical records. Overview on an ongoing development

Abstract: The introductory contribution begins with a historically oriented sketch. By referring to ancient and early modern practices, the relationship between spiritual (self-)care and various forms of

documentation is broadened. The focus is then on the documentation efforts of clinical pastoral care in the 20th century. The recording of clinical pastoral care is by no means new. The efforts of the

physician Richard Cabot and the theologian Russel L. Dicks in the 1930s show this impressively. In a

further step, more recent developments, which were important in the run-up to the electronic medical record (EMR) that produced it, are pursued. An exemplary view, namely of Kenya, expands what is depicted into another context beyond the western realm. Finally, the chapter gives an overview of the state of research and literature on the topic and some of the questions discussed therein, such as the pastoral mystery and the crucial matter of confidentiality. Possible unintended consequences of the emerging practice also are considered. Thus, the discussion is complex, multifaceted, and changing.

Keywords: Documentation, history, (self-)care, EMR, pastoral mystery, confidentiality, unintended side effects.

I. Basic considerations

Eckhard Frick 

Psychiatric-psychotherapeutic perspective

Abstract: Proactively addressing spiritual and religious (s/r) issues has a strong intervention effect on patients that is generally more important than the detailed content of spiritual screenings and assessments. When asked about s/r needs or problems, patients may feel bothered, surprised, annoyed, or, conversely, satisfied, supported, acknowledged in their coping efforts. Consequently, documentation should first of all reflect whether and how the patient reacts towards the clinician’s s/r intervention and whether and how he wants this interaction to be shared in the healthcare team. There is growing evidence that patients want that the carers to take into account the spiritual dimension of health care. Health professionals must, however, respect individual and general boundaries (non-compulsive, non-proselytizing, non-neglecting approach). In psychiatry and psychotherapy, patients’ spirituality is less pathologized than in former times and more and more accepted as a universal dimension to human experience, transcending individual religions. In mental health and in other medical fields, s/r may be part of the problem or part of the solution (K. Pargament) or both. Consequently, spiritual charting should not only differentiate pathological / negative and resilient / positive coping but also comprise the patient’s s/r health-care preferences and goals as well as the role he or she attributes to the health professional. All in all, a hermeneutical (understanding) approach is required both when communicating with the patient and when putting it into writing for the healthcare team, i.e., «translating» the patient’s spirituality and sharing it with different team members respecting their own s/r and professional belongings as well as their experiences and competencies in this field.

Key words: Spirituality, psychotherapy, team, patient

Guy Jobin 

Ethical perspective

Abstract: The introduction of EHRs into clinical practice appears to be irreversible. Where EHRs are used, chaplains have cooperated willingly with this way of reporting and sharing information with other members of the care team. They must, as a result, adapt their own note-taking practices to ensure effective, relevant, and meaningful communication as part of the joint decision-making process. Although EHRs raise ethical issues that can be described as «classic», particularly in connection with confidentiality and access, other questions, just as crucial, have received less attention in the specialized literature and are addressed here. They include recognition for all players in the care relationship (both patients and caregivers) as subjects, and the communication of «non-generic» information such as emotions, values, life history, etc.

Key words: Clinical Judgment, Confidentiality, Deontology, Ethics, Recognition

Paul Galchutt/Judy Connolly 

What We Don't Know Can Hurt Us. Spiritual Assessment Notes in Palliative Care

Abstract: The research question, «What is helpful as well as missing from palliative chaplain spiritual assessment progress notes,» arose from the context of seeking to know how palliative chaplain spiritual assessment progress notes can best be relevant and make a difference for a patient’s care. The information-rich audience to address this question were the non-chaplain palliative care team members. Seven focus groups, two of which were in a children’s hospital context, were hosted with forty-two non-chaplain palliative team participants. Through a constant comparative qualitative analysis process, the major results revealed four important considerations for palliative care chaplains. First, palliative interprofessional team members want more help and information regarding a patient’s decision making, especially related to a patient’s religion and/or spirituality. Second, and in line with palliative care principles, the participants discussed their desire for relevant notation on a patient’s sense of suffering and coping. Third, a request was made for the chaplain to consistently document his/her perception of emotion emerging from the patient and/or family. The last major result to emerge was that the progress notes should have a summary content section at the top of the note with the most important information contained there. Palliative care chaplains need to continue to hone progress-note content such that it continues to be relevant and effective in helping make a difference to reduce suffering and improve quality of life with patients and families.

Key Words: Palliative Care, assessment progress notes, interprofessional team, quality of life

II. National developments and trends

Brent Peery

Chaplaincy Documentation in a Large U.S. Health System

Commentary: Simon Peng-Keller

Abstract: Chaplaincy documentation practices in the United States have evolved over time. Variation in practice still remains. However, the trend in the profession is toward the expectation that chaplains will document their care. There is also increased expectation regarding the content of that documentation. This chapter contains some of the history and current practice of chaplaincy documentation within the Memorial Hermann Health System in Houston, Texas. It includes a discussion of the who, what, where, when, how, and why of chaplaincy documentation. Memorial Hermann chaplains strive to document care in a manner that bears witness to the holistic humanity of the care recipients. The author also describes the care in a way that helps others understand the important ways professional chaplains contribute to the wellbeing of others.

Key Words: Chaplaincy, spiritual care, charting, documentation, electronic medical record

Bruno Bélanger/Line Beauregard/Mario Bélanger/Chantal Bergeron 

Documenting Spiritual Care in Canada

Commentary: Ralph Kunz

Abstract: Over the past decade or so, the quality of the evaluation note written by a spiritual care provider (ISS) has been a major issue in accountability and the quality of interdisciplinary collaboration. This chapter proposes two models of notes: «the note following a meeting with a user», generally used in acute care, and «the note following a meeting with a relative», generally used in long-term care, in cases where a patient can no longer express himself. These two charting models were developed on the basis of the RESS (Benchmarks for Spiritual Care Assessment) assessment tool, recently developed at the CSsanté, whose usefulness and applicability were assessed in a research study. The note models presented in this chapter are essentially inspired by the vision of spirituality underlying the work of accompanying patients and the development of the RESS. The authors found that the clinical benefits of streamlining an evaluation and note-writing model are a major step forward in a profession that has been rapidly evolving in Quebec in recent years.

Keywords: Quebec, spiritual care, quality of interdisciplinary collaboration, spirituality, benefits

Christine Hennequin 

Documenting Spiritual Care in Australia

Commentary: Livia Wey-Meier

Abstract: Documentation in medical records is an important aspect of providing care in Australian health services. Documenting spiritual care in health services has evolved over many decades. A brief historical overview of the models of chaplaincy in Victoria, Australia from the 1950s shows the development from faith-based models to more professional models in the last two decades. Models may include spiritual care faith representatives and volunteers; access to medical records differs for each of these providers. Data collection and describing pastoral interventions in the 1990s as part of an Allied Health project at Austin Health, Heidelberg Victoria was a key milestone as was the inclusion of pastoral care intervention codes in the Australian ICD-10_AM/ACHI/ACS codes in 2002. As a peak body, the Healthcare Chaplaincy Council of Victoria and later Spiritual Health Victoria continued to develop documentation guidelines including consistent ways of collecting data and describing interventions. Reporting on spiritual care activity to the Victorian government’s Department of Health and Human Services emphasised this requirement to develop a minimum dataset and to educate the spiritual care sector. A Spiritual Care Minimum Data Set Framework was developed in 2015 and evaluated. Revised guidelines were disseminated by Spiritual Health Victoria in 2019. Three case studies of Victorian hospitals illustrate how documenting in electronic and paper medical records currently meet the Spiritual Health Victoria guidelines. Documentation assists with the integration of spiritual care in the health service, with internal reporting and with research. It also enables spiritual care activity to be visible and available electronically for reporting to government as required.

Key Words: Documentation, medical records, models, pastoral care, spiritual care, chaplaincy, intervention, data, framework, guidelines

Wilfred McSherry/Linda Ross 

Documenting Spiritual Care in the U.K.

Commentary: David Neuhold

Abstract: This chapter explores how spiritual aspects of care are being documented within the United Kingdom (UK) with a specific focus upon health care, primarily the nursing and chaplaincy professions. This has not been an easy undertaking given the lack of a standardised approach, the changing and challenging landscape of health care in the UK, and the conflicting terminology used when trying to assess, capture, and record encounters, interactions, and conversations with patients and their carers about their spiritual needs. The authors draw upon their own research and informal enquiries with chaplains from across England, Scotland, and Wales, demonstrating that there is a wide range and variation in practice. The authors conclude that there is no standardised means of assessing and documenting spiritual needs and care in the UK and that this is unlikely to become a reality until the many complex challenges outlined are addressed both politically and professionally.

Key Words: Chaplaincy, nursing, spiritual care, charting, documentation, England, Scotland, Ireland, Wales

Wim Smeets/Anneke de Vries 

Spiritual Care and Electronic Medical Recording in Dutch Hospitals

Commentary: David Neuhold

Abstract: Among Dutch Healthcare Professionals, it is not a foregone conclusion that conversations with patients should be recorded electronically. This chapter first describes the discussion among them about the pros and cons of EMR. The authors then discuss the Dutch and European legislator’s requirements for the protection of patients’ privacy and therefore of their stories, and how these requirements work out in EMR’s practice. The third section is devoted to the question as to why spiritual caregivers should actually record their conversations with patients. The authors put forward various arguments for this. In their view, charting appears to serve both the interests of patients and the interests of the healthcare providers and of the spiritual care professionals themselves. The authors then describe various possible methods of registration, including G. Fitchett’s model in an adapted, more secular form. By means of two cases, one fairly extensive and one more concise, they show how registration takes place in practice at the Radboudumc. The chapter concludes with the formulation of plans and wishes for the near future.

Key-Words: EMR – Legislation – Registration models – Healthcare providers – Hospital – umc

Anne Vandenhoeck 

Documenting Spiritual Care in Belgium

Commentary: Eva-Maria Faber

Abstract: The main motive for spiritual care givers to chart in electronic patient files should be to contribute to the best possible spiritual care for patients and their loved ones. The culture in health care has always influenced spiritual care and vice versa. The contemporary economic paradigm in health care fuels core concepts like quality of care, efficiency, interdisciplinary care, and patient-centered care. Electronic patient files serve multiple of those core concepts and it is important for spiritual caregivers to be accountable in their service to patients and loved ones. In this contribution the author explores charting by spiritual caregivers in the context of general hospitals in Flanders, Belgium. The main charting system, which is used by a big cluster of hospitals in Flanders, includes space for the spiritual caregivers to chart. The language used is based on the Discipline for Pastoral Care Giving, an outcome-based model for spiritual care by the late Arthur Lucas. In this contribution the author reflects on several ways of charting and touches upon several tensions: the tension between sharing and confidentiality, between charting for yourself and for an interdisciplinary team, between time to chart and time to visit. From the perspective of tensions, charting remains an interesting medium to reflect upon the contemporary content of spiritual care and the position of spiritual caregivers in health care.

Keywords: Spiritual caregivers as bearers of patients’ stories, interdisciplinary patient file, confidentiality, functional narrative charting, continuity in care for the patient’s story, outcomes of spiritual care

Pascal Mösli 

Emerging practices in Switzerland

Commentary: TBD

Abstract: The pastoral documentation is developing rapidly in Switzerland. As part of the palliative complex treatment required by hospitals, developed independently by pastoral teams in the interprofessional context of large hospitals, it has also found its way into current standard papers of pastoral expert committees. In order to understand how pastoral care professionals throughout Switzerland think about documentation, a survey of German-speaking pastoral care professionals was conducted in spring 2019. The response rate was 54%, so the results of the survey provide a good insight into the Swiss situation. The results show that there is also a major upheaval in the minds of pastoral care professionals. While about 50% of all pastoral professionals in Switzerland document pastoral work in some form, more than 70% of those who do not currently document could imagine – under certain conditions – documenting. The chapter informs about the development of the pastoral documentation, contexts, and framework conditions of the healthcare system and the church, and their meaning from the point of view of the pastoral professionals themselves.

III. Challenges and perspectives for the future

Simon Peng-Keller 

Challenges and perspectives for the future

Abstract: In a first step, the final contribution to the volume collects and organizes the various topics of the discussion. Second, it filters out the critical and controversial points as well as the convergences in the transnational developments. Third, the desiderata for research is articulated and some ideas for future research programmes are formulated. The chapter concludes with a sketch of a future practice of recording spiritual care.

O autorze

Prof. Dr. Simon Peng-Keller is professor of Spiritual Care at the University of Zürich in Switzerland. He also works as healthcare chaplain at the palliative care unit of the University Hospital Zurich. His current research areas of interest include interprofessional spiritual care and healthcare chaplaincy, visionary experiences near death, spiritual needs in palliative care, and theology of spirituality.

David Neuhold, PD Dr., Mag. Theol., is postdoc research associate at the professorship of Spiritual Care on the Faculty of Theology at the University of Zürich in Switzerland. Dr. Neuhold also is an editor of the Swiss Journal for Religious and Cultural History (SZRKG/RSHRC) at the University of Fribourg, Faculty of Philosophy, in Switzerland.

 

Blurb

This open access volume is the first academic book on the controversial issue of including spiritual care in integrated electronic medical records (EMR). Based on an international study group comprising researchers from Europe (The Netherlands, Belgium and Switzerland), the United States, Canada, and Australia, this edited collection provides an overview of different charting practices and experiences in various countries and healthcare contexts. Encompassing case studies and analyses of theological, ethical, legal, healthcare policy, and practical issues, the volume is a groundbreaking reference for future discussion, research, and strategic planning for inter- or multi-faith healthcare chaplains and other spiritual care providers involved in the new field of documenting spiritual care in EMR.

Topics explored among the chapters include:

• Spiritual Care Charting/Documenting/Recording/Assessment
• Charting Spiritual Care: Psychiatric and Psychotherapeutic Aspects           
• Palliative Chaplain Spiritual Assessment Progress Notes                 
• Charting Spiritual Care: Ethical Perspectives            
• Charting Spiritual Care in Digital Health: Analyses and Perspectives

Charting Spiritual Care: The Emerging Role of Chaplaincy Records in Global Health Care is an essential resource for researchers in interprofessional spiritual care and healthcare chaplaincy, healthcare chaplains and other spiritual caregivers (nurses, physicians, psychologists, etc.), practical theologians and health ethicists, and church and denominational representatives.