the professional chaplain: taking the lead in integrating ... › docs › 2015...6 the three points...
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The Professional Chaplain: Taking the Lead in Integrating Spiritual Care Through Clinical
Practice, Education, and Research
The Rev. George Handzo, BCC, CSSBB
Director, Health Services Research & Quality
HealthCare Chaplaincy Network
New York, NY
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Objectives
• Describe the role of the multi-faith chaplain in palliative care.
• Make the case for professional chaplaincy in their own setting.
• More effectively integrate and deploy chaplaincy resources in their healthcare setting.
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Definitions
• Chaplain
• Spiritual Care
• Chaplaincy Care
• Pastoral Care
• Assessment- Screening, History
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Spirituality
Spirituality is the aspect of humanity that refers
to the way individuals seek and express
meaning and purpose and the way they
experience their connectedness to the moment,
to self, to others, to nature, and to the
significant or sacred.
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Palliative Care
Palliative care is an approach that improves
the quality of life of patients and their families
facing the problem associated with life-
threatening illness, through the prevention
and relief of suffering by means of early
identification and impeccable assessment
and treatment of pain and other problems,
physical, psychosocial and spiritual.
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The Three Points of the Sermon
• We know that spirituality & religion are important in coping with illness- especially as we age or approach death.
• When spiritual needs are met, good things happen.
• Chaplains are the spiritual care leads so every team needs one.
• The opportunities for further integration of spiritual care are many and, if taken, will result in better medical outcomes and lower cost care.
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The Issue of Religion
• The merging of science and religion
• Enabling the practice of spirituality & religion
• We all have thoughts and feelings about this plus or
minus.
• A lot of us think we know something about it and what
it should be for others- what people should believe or
what is good for them to believe.
• Having a chaplain (religious person) on the team is
contentious.
• Professional ethics, Confidentiality
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What Is Spiritual Care
Today?
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Research: What Do We Know?
• Spirituality/religion impact health outcomes.
• Spirituality/religion are important to most
people in coping with illness.
• Most people want their spiritual/religious
beliefs and practices taken into account in
their health care.
• If spiritual/religious needs are met, outcomes
improve including medical outcomes, cost
reduction and patient satisfaction.
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Research: What Don’t We Know?
How helpful or harmful are particular
healthcare chaplaincy activities delivered by
particular chaplains on behalf of particular
people dealing with particular problems in
particular social contexts according to
particular criteria of helpfulness and
harmfulness?
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Clinical Practice: The Model
• With thanks to Puchalski & Ferrell
• Honorable mention to the Archstone Foundation
• Generalist/Specialist Model
• Spiritual care is everyone’s job
• Chaplains are the spiritual care lead
• Referral practice focused on spiritual distress
• Screening, History, Assessment, Diagnosis, Plan
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Clinical Practice: The Guidelines
• World Health Organization
• National Consensus Project
• National Comprehensive Cancer Network
• Standards of Practice
• The Joint Commission
• Specialty Certification
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Education
• Clinical Pastoral Education
• Interpersonal skills
• Acceptance, non-judgmental
• Presence, listening
• Communication, listening
• Core for palliative care
• Not knowledge- research literacy, palliative care
• Multidisciplinary practice
• Who we are and what we do
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The Deficits
• Training for chaplains not mandated
• Emerging evidence but most chaplains not
trained to take advantage of it- research
literacy
• No standard practice
• No agreement on outcomes or value added
• Deficits more acute in smaller and rural
institutions especially hospice
• Reimbursement only in hospice
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The Way Forward
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The End Game
• Understanding what spiritual care interventions
contribute to positive health outcomes, reduction in
the costs of care, and reduction of suffering for
patients and family members.
• Education for all clinicians on spiritual care provision
within their scope of practice.
• Systems to provide best practice spiritual care most
effectively and efficiently across the continuum of
care.
• Reimbursement for provision of best practice spiritual
care
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How Are We Going to Get
There?
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Palliative Care is the Way
• Palliative care is essential to achieving the
triple aims.
• Care for the human spirit is essential for
achieving the promise of palliative care.
• Trained and fully integrated chaplains are
essential to driving good spiritual care.
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Quality Improvement is the Way
• The theological imperative
• Don’t accept the status quo
• Palliative care has done that- of course you
have pain
• Of course you are depressed
• Have to know outcomes
• Be willing to test, test, test
• Measure everything
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But You Can’t Measure the
Spiritual
• This is not about the existence of God or the
truth of religious claims or the validity of faith
• The lesson from pain management
• The lesson from particle physics
• Assessment, Intervention, Outcome
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Clinical Care-Take the
Generalist/Specialist Model
Seriously
• Transdisciplinary- no silos
• Unsilo- things nurses and social workers can
do and some they can’t
• Links to the community
• Systems & processes- chaplains, clergy,
volunteers
• Not be afraid to sell the store- miracles,
culture
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The Role of the Spiritual Care
Specialist
• Put systems in place
• Train generalists
• Liaison with faith communities
• Assess and plan for those in distress
• Support the spiritual life of the team
• Embrace technology
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Clinical Practice- Process
• Screening, History
• Referral based on need
• Triggers
• Assessment & Communication with Team
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Education
• Match needs and skills
• What are the needs?
• What do patients want?
• Developing a Curriculum (DACUM)
• Rebalance skills and knowledge
• Chaplaincy School
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Final Words
• Only the best care- efficient and effective
• Embrace technology
• Have a sense of urgency- raise the bar
publicly
• Its not about our turf, its about reducing
suffering for patients and caregivers.
• How do we stay in the game but not lose our
souls?
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Thank You