Creative models of spiritual care. As healthcare delivery changes, pastoral care departments must explore alternative staffing approaches

Recognizing changes are coming to the healthcare delivery system, pastoral care departments are developing a new vision of spiritual care. As they educate and hire staff, many directors are finding that alternative staffing approaches can help them make the transition. Flexible schedules for pastoral care professionals improve the care they deliver and enhance morale. Restructuring responsibilities within the department and giving some patient populations priority can be helpful. Some facilities share chaplains' time to minimize on-call burden; others are increasingly using supervised volunteers. Pastoral care givers who are specialists in areas such as mental health and chemical dependency can often perform certain functions traditionally performed by other professionals. By assigning chaplains to a product or service line, pastoral care departments can improve the continuity of care patients receive. As parishes' role in the healing ministry takes on new meaning, healthcare institutions' pastoral care staff can help initiate and develop new parish services or provide assistance that complements existing parish efforts.     

Support in a time of need. The team approach at Mercy Medical Hospice addresses medical, emotional, and spiritual needs

Mercy Medical Hospice, Daphne, AL, uses an interdisciplinary team approach, which includes medical, nursing, social work, pastoral care, pharmacy, therapies, volunteer, and bereavement services. Mercy Medical has two home care offices and offers inpatient respite care for short periods, which is helpful for those who have an inadequate care giver system or need time to work out a better alternative to care in the home. An assessment of medical and nursing care needs, mental and emotional state, and psychological and spiritual needs is the first step after patients enter hospice. The entire team develops a care plan for the patient and family. Among the issues they address are education about the disease process, medication for pain control and symptom management, and how the patient and family cope with the patient's imminent death. Working with the dying and their families can be stressful for staff members, and they offer each other a lot of support. Working in hospice requires good stress management techniques, but staff feel that it is a calling that enriches their lives.     

Pastoral care's role in a reformed system. Pastoral care professionals need to promote the spiritual dimension of healing throughout the continuum of care

The emerging structure of healthcare delivery is challenging many elements of traditional pastoral care. With these changes, how can pastoral care professionals be on the cutting edge of tomorrow's pastoral care ministry? Pastoral care givers must understand that the individual with holistic needs will be at the center of the reformed healthcare system. All providers will share the responsibility and financial risk of providing high-quality care to each client. Pastoral care departments will need to develop systems to objectively measure the quality of their spiritual and religious care services, as well as patient or client satisfaction. Pastoral care professionals must take the lead in developing a vision of spiritual care that reflects the new paradigm of integrated delivery. They must also share the vision of integrated spiritual care with opinion leaders who can be advocates for an expanded vision of pastoral and spiritual care within the network. Ideally, faith communities should be centers for care, healing, and wellness, with hospitals as extensions of those communities. Within such a network, pastoral care givers can organize programs, workshops, and retreats around spirituality and wellness as part of the faith community's mission. In addition, pastoral care professionals can help clients learn about themselves and their life-styles and make healthier choices. Pastoral care givers need to recognize that within brokenness there is also wholeness, wisdom, and new opportunities. When we are free of our own agenda, we can empower others. Together, with God's grace, pastoral care givers can shape a new future and make it happen.     

Rural Nonphysician Providers'' Perspectives on Palliative Care Services in Northwestern Ontario, Canada

Most palliative care in rural remote areas is provided by nonphysicians. This paper reports a survey of interdisciplinary rural health service providers (not including physicians) to identify the strengths and weaknesses in palliative care service delivery in a rural and remote region in northwestern Ontario, Canada. Questionnaires were sent to 156 nurses, homemakers, social workers, and pastoral care workers who care for terminally ill persons and their families, and 122 were completed and returned (response rate 78%). Consistent with practice in most rural areas, 90% of respondents were generalists. Respondents identified several problems with palliative care services, including inadequate training for caregivers, inadequate support services for family and professional caregivers, inadequate human resources, and lack of organized volunteer programs. Suggestions for improvements included better education for service providers; better availability of palliative care services; more counseling and support services for patients, family members, and professionals; and greater availability of respite beds. Overall, respondents rated clients' needs as being better met than their own. The most frequently reported problems for care providers were related to the lack of supports for care provision.     

The Pastoral Pool: an evaluation of a new system of pastoral care provision

CONTEXT: Medical students experience significant stress and stress-related problems. The benefits of support during training are described in this paper. Recently, student support systems have become increasingly stretched as medical schools merge, courses become modular and staff face increasing clinical and research pressures. The pastoral support system at St Bartholomew's and the Royal London School of Medicine has been changed in response to an evaluation of the old system of personal tutors. Pastoral care is now provided by a group of willing staff members known to have an interest in student welfare. The group is known as the 'Pastoral Pool' (PP). METHODS: Students and staff PP members completed similar questionnaires addressing their expectations of the PP and identifying the need for support systems in general. Pastoral Pool activity was investigated using confidential record sheets stating the frequency, duration and content of each PP encounter. RESULTS: Students were aware of the PP and many would consider using it. Staff and students agreed over the functions of the PP. Students frequently expressed concerns over confidentiality within the system. Uptake was low, with only 3% of students approaching the PP and the majority of PP work performed by only two staff members. The content of meetings was often multifactorial and usually on a subject within the PP remit. CONCLUSIONS: The PP is beneficial because pastoral care is provided only by dedicated staff members with an interest in student welfare. Membership is small enough to enable staff training and development. However, the system relies on self-referral by students. Rather than preventing problems arising, it therefore provides secondary support to those students insightful enough to identify their problems and motivated enough to seek help.     

The science of caring

A downsizing crisis at Mount Carmel Medical Center, Columbus, OH, forced its Pastoral Care Department to begin thinking in terms of accountability. Trained in an intuitive style of chaplaincy, the staff distrusted a clinical approach to pastoral care. Nonetheless, when they found themselves scrambling to justify their existence, the entire department staff literally withdrew from the hospital for two days to redesign pastoral care. What evolved was a process of "focused care." It represented a radical departure from their traditional assumptions about chaplaincy in that henceforth they would (1) base their ministry on assessment of spiritual need, with primary attention to high-risk patient populations, (2) continue to provide eucharistic ministry through volunteers, but no longer rely on Catholic chaplains to carry out those duties, (3) no longer assume that a chaplain needed to be present at every death or medical crisis, and (4) no longer assume that the impact of a spiritual ministry could not be objectively measured.     

The Role of the Healthcare Chaplain: A Literature Review

Healthcare chaplains operate in many healthcare sites internationally and yet their contribution is not always clearly understood by medical and healthcare staff. This review aims to explore the chaplains’ role in healthcare, with a view to informing best practice in future healthcare chaplaincy. Overall the extent of the provision and staffing of chaplaincy service internationally is unclear. From this review, several key spiritual and pastoral roles in healthcare emerge including a potential contribution to ethical decision making at the end of life. Healthcare chaplains are key personnel, already employed in many healthcare organizations, who are in a pivotal position to contribute to future developments of faith-based care, faith-sensitive pastoral, and spiritual care provision. They also have a new and evolving role in ethical support of patient, families and healthcare teams.     

Transforming Chaplaincy: The Emergence of a Healthcare Pastoral Care for a Post-Modern World

This article provides a snap shot of the current position and recent developments in chaplaincy in health care settings particularly in England, Scotland, the United States of America and Australia in order to guide the emerging modernization agenda in the Australian context, and to assist the acceleration of the local adoption of best practice in pastoral care. Over all, the picture is one of change. As hospitals develop to meet new performance expectations services that work within the hospital system, such as chaplaincy and pastoral care, must also adapt. Rather than chaplaincy being discarded as marginal during these changes, recent research evidence supports the inclusion of pastoral care in holistic health care. Demographic changes also mean that pastoral care needs to have an emphasis on spiritual support if it is to respond to patients of other faith traditions or with secular beliefs.     

Home is where the heart is. Ministering to homebound patients opens new doors for pastoral care givers

Today many patients must convalesce or die at home. Thus home healthcare is a growing service. Many home health agencies are finding that caring for patients' spiritual needs can be just as important to their well-being as caring for their physical needs. Four years ago Humboldt Home Health Services (HHHS), Eureka, CA, launched a pastoral care program in response to a growing patient need. HHHS now offers pastoral care free to all its patients. Each certified pastoral care counselor on the staff visits three to five patients each day. They encourage patients to tell their stories, describe adjustments they have had to make to their illnesses, and explore how they are coping emotionally and spiritually with their situations.     

The renaissance of pastoral care

Administrators are finding pastoral care has a future, and a vital one. Without question, the chaplaincy of the future will not be the same as the chaplaincy of the past. Its theology will remain a constant, and its roots will hold fast, but the services will change, along with the healthcare environment in which it operates. If it wants to be an integral part of the clinical team, pastoral care must address three critical areas: spirituality, outreach, and accountability. Healing is spiritual. The meaning and purpose patients find in life, as well as their involvement with the spiritual, are key healing indicators in their treatment. As the spirituality movement articulates its value within the practice of medicine, pastoral care departments are likely to be its principal catalysts. Pastoral care departments are reassessing their ability-and the need-to see every patient, and instead are identifying those patients who will most benefit from pastoral intervention. At the same time, pastoral care services are extending beyond the hospital and will be based in many other settings in the future. If pastoral care hopes to be indispensable in the healthcare setting, it must demonstrate that it makes a contribution and a difference. This requires developing and applying clinical standards to its ministry, as well as creating an empirical data base to substantiate the efficacy of pastoral care interventions.     

Integrating prenatal-postnatal smoking interventions into usual care in a health maintenance organization

Consistent with the increasing national emphasis on providing health promotion in clinical care settings, Stop Smoking for OuR Kids (STORK), a research-derived, prenatal-postnatal smoking cessation intervention, was implemented throughout prenatal clinics, inpatient postpartum services, and pediatric clinics of Kaiser Permanente Northwest. Process data collected during the project rollout and maintenance to monitor the clinical practices of clinicians and staff members, patient responses to the intervention, and penetration of the intervention into the health maintenance organization priority population of prenatal smokers high-lighted barriers to intervention delivery. These barriers fell into three categories related to the smoking intervention design, clinicians and staff members, and the organization. By monitoring the intervention implementation process, such problems were identified early. This allowed for implementing strategies to overcome many of these barriers and to assess their effectiveness. Keys to implementation success included simplifying the intervention activities, considering stakeholder needs, and providing tangible organizational resources and goals.     

The home health care routing and scheduling problem with interdependent services

This paper presents a model for the daily planning of health care services carried out at patients’ homes by staff members of a home care company. The planning takes into account individual service requirements of the patients, individual qualifications of the staff and possible interdependencies between different service operations. Interdependencies of services can include, for example, a temporal separation of two services as is required if drugs have to be administered a certain time before providing a meal. Other services like handling a disabled patient may require two staff members working together at a patient’s home. The time preferences of patients are included in terms of given time windows. In this paper, we propose a planning approach for the described problem, which can be used for optimizing economical and service oriented measures of performance. A mathematical model formulation is proposed together with a powerful heuristic based on a sophisticated solution representation.     

End-of-life care: perspectives of family members of deceased patients

This study was undertaken to determine the opinions of family members of deceased patients regarding end-of-life care. This multisite cross-sectional survey was administered to 969 volunteer participants during 1997 to 2000. Eligible participants included immediate family members of deceased patients at five local institutions in a regional health system. Among 969 respondents, most (84.4 percent) indicated that the care for their family member was excellent. Reasons cited for satisfaction included overall care (40.2 percent), staff effort (23.2 percent), and communication (16.4 percent). Reasons cited for dissatisfaction included perceived incompetence (9.7 percent), perceived uncaring attitude (8.4 percent), and perceived understaffing (3.7 percent). Respondents were more satisfied with communication from nursing staff (88 percent) than physicians' communication (78 percent, p < 0.001, Bowker's test). Respondents indicated higher overall satisfaction with nursing (90 percent) and pastoral care (87 percent), than with physician care (81 percent, p < 0.001 and p = 0.006, Bowker's test). A unique survey instrument can be used to measure family perceptions and opinions regarding end-of-life care.     

Measuring Patient Satisfaction in Primary Care: a Joint Project of Community Representatives, Clinic Staff Members and a Social Scientist

We describe the process of planning and developing a questionnaireand conducting a patient satisfaction survey in a neighbourhoodclinic in Beer-Sheva, Israel. The project was conducted by theclinic staff members, patient representatives and a medicalsociologist. The satisfaction survey was conducted in patients'homes, with a 67% response rate. General satisfaction and satisfactionwith specific components of service are described. Patient satisfactionwas higher among men than among women, and negatively correlatedwith family size. The strongest predictor of general satisfactionwas satisfaction with physicians' services. Implications ofthe survey results were decided upon by active collaborationbetween the clinic staff and the patient representatives. Theinferences drawn from the patients' replies and the changesintroduced as a result of them, are discussed. Health care consumersshould be active participants in carrying out surveys of satisfactionon a regular basis.     

UMMC recruitment plan succeeds. Multi-disciplinary approach aligned to overall marketing strategy

At the University of Maryland Medical Center (UMMC), Baltimore, a team of marketing, human resources and patient care services departments staffers worked on a campaign to recruit staff members. They created a successful campaign that exceeded by 12% the four-month goal for new hires. Reportedly, the program has had lasting momentum and has helped to enhance the image of UMMC. Incidentally, the campaign also won peer recognition for its creators.     

The Danish health care system from a British perspective.

The organisation and financing of the Danish health care system was evaluated within a framework of a SWOT analysis (analysis of strengths, weakness, opportunities and threats) by a panel of five members with a background in health economics. The evaluation was based on reading an extensive amount of selected documents and literature on the Danish health care system, and a one-week visit to health care authorities, providers and key persons. The present paper includes the main findings by one of the panel members. The dominance of tax financing helps to achieve control over the level of health care expenditure, as well as securing equity in financing the services. The reliance on local government for financing and running health care has both advantages and disadvantages, and the split between county and municipal responsibility leads to problems of co-ordination. The remuneration of general practitioners by a mix of capitation payment and fee for services has the advantage of capping expenditure whilst leaving the GPs with an incentive to compete for patients by providing them with good services. The GP service is remarkably economical. The hospital sector displays much strength, but there seem to be problems with respect to: (i) perceived lack of resources and waiting lists; (ii) impersonal care, lack of continuity of care and failures in communication between patients and staff; (iii) management problems and sometimes demotivated staff. The relationship between patients and providers is facilitated by free access to GPs and absence of any charges for hospital treatment. The biggest threat is continuation of avoidable illness caused by poor health habits in the population. The biggest opportunity is to strengthen public health measures to tackle these poor health habits.     

Evaluation of a Chaplain Residency Program and Its Partnership with an In-Patient Palliative Care Team

In 2009 a Consensus Conference of experts in the field of spiritual care and palliative care recommended the inclusion of Board-certified professional chaplains with at least 1,600 hours of clinical pastoral education as members of palliative care teams. This study evaluates a clinical pastoral education residency program’s effectiveness in preparing persons to provide spiritual care for those with serious illness and in increasing the palliative care team members’ understanding of the chaplain as part of the palliative care team. Results showed chaplain residents felt the program prepared them to provide care for those with serious illness. It also showed that chaplain residents and palliative care team members view spirituality as an integral part of palliative care and see the chaplain as the team member to lead that effort. Suggested program improvements include longer palliative care orientation period, more shadowing with palliative care team members, and improved communication between palliative care and the chaplain residents.     

Pastoral care: recognizing life as multidimensional

Human life is multidimensional; physical illness touches both the physical and spiritual dimensions. Total health is possible only when the body and spirit are integrated into one reality. The pastoral care department's goal is to integrate scientific growth and spiritual values--for patients and staff alike--to ensure the spiritual dimension of healing.     

Moving specialist care into the community: an initial evaluation

OBJECTIVES: To assess the likely impact on patients and local health economies of shifting specialist care from hospitals to the community in 30 demonstration sites in England. METHODS: The evaluation comprised: interviews with service providers at 30 sites, supplemented by interviews with commissioners, GPs and hospital doctors at 12 sites; economic case studies in six sites; and patient surveys at 30 sites plus at nine conventional outpatient services. Outcomes comprised: staff views of service organization and development, impact on primary and secondary care, and benefits for patients; cost per consultation and cost per patient in new services compared to estimates of the price of services if undertaken by hospitals; patients' views of waiting time, access, quality (technical and interpersonal), coordination and satisfaction. RESULTS: New services required high initial investment in staff, premises and equipment, and the support of hospital consultants. Most new services were added to existing hospital services so expanded capacity. Patient reported waiting times (6.7 versus 10.1 weeks; p = 0.001); technical quality of care (96.2 versus 94.5; p < 0.001), overall satisfaction (88.2 versus 85.4; p = 0.04); and access (72.2 versus 65.8; p = 0.001) were significantly better for new compared to conventional services but there was no significant difference in coordination or interpersonal quality of care. Some service providers expressed concerns about service quality. New services dealt with less complex conditions and undercut the price tariff applied to hospitals thus providing a cost saving to commissioners. There was some concern that expansion of new services might destabilize hospitals. CONCLUSIONS: Moving specialist care into the community can improve patient access, particularly when new services are added to existing hospital services. Wider impacts on health care quality, capacity and cost merit closer scrutiny before rollout.