How to meet JCAHO’s pastoral care standards

Integrate spiritual care into overall care plan

Now that the Oakbrook Terrace, IL-based Joint Commission on Accreditation of Healthcare Organizations (JCAHO) is taking an active interest in how pastoral care is provided in hospitals, the field is changing rapidly, experts say. As a result, it’s become more important than ever to examine how spiritual care is integrated into a patient’s overall plan of care.

According to Rev. Terry Culbertson, director of pastoral care of the Syracuse-based Interreligious Council of Central New York, "There has been an increase in the Joint Commission’s standards pertaining to who provides spiritual care, so many people are now seeking certification. This focus has changed the face of spiritual care." Culbertson says that to become certified and to meet the JCAHO standards, a pastoral counselor must meet rigid and arduous goals similar to a board certification.

"The Joint Commission and JCAPS [the Joint Commission on Accreditation of Pastoral Services] now look at things like how spiritual care is integrated into the overall care plan and how a patient’s spiritual needs are assessed," says Culbertson. The commissions have stringent standards about everything from the elements in an assessment to how documentation must be done, and even the inclusion of pastoral service in the chart. Institutions must now have written policies and procedures, certified supervision, professional staffing, sufficient budget allocations, and appropriate physical space for the provisions of pastoral services. Pastoral staff are now mandated to be involved in patient care conferences as well as the discharge planning process.

"This is a collaborative effort within the pastoral care movement," explains Culbertson. JCAHO surveyors review assessment documentation in the patient’s medical records to determine if the patient’s spiritual needs are being met. Assessments in general discover a patient’s spiritual status and needs, including the concerns of an individual who is faced with death, such as hope, despair, guilt, or forgiveness. Once a patient’s spiritual needs are discovered, a plan can be created to meet those needs.

The JCAHO standards clarification states that "Spiritual assessment should, at a minimum, determine the patient’s denomination, beliefs, and what spiritual practices are important to the patient. The information would assist in determining the impact of spirituality, if any, on the care/services being provided and will identify if any further assessment is needed. The standards require organizations [such as hospitals, rehabilitation centers, correctional institutions, etc.] to define the content and scope of spiritual and other assessments and the qualifications of the individual(s) performing the assessment."

The JCAHO further notes the following as elements and questions to patients and their families that could be, but are not required to be, included in a spiritual assessment:

- Who or what provides the patient with strength and hope?

- Does the patient use prayer in his or her life?

- How does the patient express his or her spirituality?

- How would the patient describe his or her philosophy of life?

- What type of spiritual/religious support does the patient desire?

- What is the name of the patient’s clergy, minister, chaplain, pastor, or rabbi?

- What does suffering mean to the patient?

- What does dying mean to the patient?

- What are the patient’s spiritual goals?

- Is there a role of church/synagogue in the patient’s life?

- Has belief in God been important in the patient’s life?

- How does faith help the patient cope with illness?

- How does the patient keep going day after day?

- What helps the patient get through this health care experience?

- How has illness affected the patient and his or her family?