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When patients suffer, their natural instinct is to turn to things close to the heart for comfort: family, personal values, or spiritual beliefs.
Over the last few years, more health care ethics committees are recognizing the importance of spiritual beliefs in the healing process and in patients’ and families’ ability to cope with disease or death. As caregivers pay more and more attention to improving end-of-life care, they also are recognizing the importance of meeting patients’ spiritual needs.
"We can’t make the assumption that everyone is religious, but we do make the assumption that everyone has a spiritual dimension," says J. Vincent Guss, MDiv, director of pastoral care at Alexandria (VA) Hospital and chairman of the bioethics committee at the Chicago-based College of Chaplains. "Having a strong religious background is not the only indication of a person’s spiritual needs," cautions Woodley. "At some point in life’s journey, everyone needs spiritual care and comfort," he says.
Caregivers are finding that help in this regard lies right within their midst. Providers are discovering an invaluable resource that has been virtually untapped the chaplain or trained pastoral care professional.
"Most staff and even family members don’t know the extent of how we can help. They think our only role is to pray with the patients and give the sacraments," says Margaret McClaskey, MDiv, director of pastoral care and ethics committee chair at Rush Northshore Medical Center in Skokie, IL.
While not downplaying the importance of these duties, she urges pastoral care ministers to inform health care professionals that they can do much more to alleviate suffering. She recommends they demonstrate and document how and when they can help with a patient’s care. (See list of ways pastoral care can be used as resource, p. 58.)
Clergy certified in health care pastoral ministry are valuable members of the health care team, says Rich Woodley, MDiv, director of pastoral ministry and ethics committee chair at the Santa Rosa Health Care System in San Antonio. The system includes hospitals, home health facilities, and hospice care. Certified clergy have additional training in health care, including a year of supervised clinical practice and expertise in helping patients and families cope with a variety of psychosocial needs, he points out.
McClaskey and Woodley, by directing their institutions’ pastoral care teams and ethics committees, exemplify the powerful role a chaplain can play and the value they can add to an institutional ethics program. "I started my job by developing a strategic plan for pastoral care. I set the tone for what my role would be," McClaskey says.
In six years, McClaskey has reported to three different vice presidents, but she has stuck with her strategic plan. Her tenacity has led her to participate in medical staff meetings and new resident and nursing orientations. "I use these meetings as an opportunity to say, Here are all the reasons you should call pastoral care.’"
Woodley urges chaplains to build working relationships with other members of the health care team and with top administrators. Chaplains should routinely participate in nurse staff meetings and discharge planning, he says. "This is where the patient is and where we can often lend the most support." During discharge planning, chaplains can help assure a continuum of care among hospital, home health, hospice, or long-term care. "Contact the parish clergy in the patient’s area and find out who can continue to offer spiritual support to the patient and family," Woodley says.
Pastoral care professionals not only must make themselves known within their institutions, but they must document their value in today’s cost-conscious health care environment, Woodley says. There are different models for documenting your interaction with patients and assessing their spiritual needs. Some include a review of patients’ spiritual values and religious traditions. Others are more indicative of patients’ feelings.
In addition, Woodley says pain management assessments should include the level of spiritual anxiety or pain that patients may be experiencing, and how it is being addressed.
Woodley and McClaskey advise against using a checklist during patient assessments. Rather, "Develop your own model; use key phrases consistently in writing a chart note; tell the patient’s story in broad terms," Woodley says.
Many pastoral care ministers neglect to chart patients’ spiritual needs because of confidentiality issues. But, "You can word the situation in a way that does not spell out the specific problem. For example, if a person is feeling guilty and is afraid, chart how he or she feels about the afterlife, about their image of God, not the particular reason for their guilt," he explains.
McClaskey says the chaplain’s most important job is to listen to the patient and build a bond of trust. "For the chaplain to be able to help in a difficult situation, the patient and family members have to feel that this is someone they can trust and confide in, someone who will listen to their concerns and not pass judgment," she says. "I used to feel bad when someone cried. Now I know that when this happens I am really doing my job. People have to feel comfortable discussing their fears and their hopes and how their understanding of God impacts the situation."
A strong pastoral care team also can be instrumental in helping staff members cope with their own feelings of grief, loss, and frustration when a patient dies, says McClaskey. Chaplains should emphasize that each patient and each family perceives the dying experience in a different way. Conduct staff discussion groups so they can air personal feelings about death and dying and handle differences between their opinions and those of patients and families, she urges.
"We cannot impose our own popularized or secularized notions of our own wishes about a good death on others," Woodley says. Some family members choose not to be present at the moment of death, for example. "Some patients prefer to die alone, not hovered over. Some Native American tribes believe that the patient is meant to be alone."