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.     

Health care reform: opportunities for professional chaplains to build intentional communities of learners by integrating faith, science, quality, and systems thinking

Albert Einstein once said, "The significant problems we face cannot be solved at the same level of thinking we were at when we created them" (www.brainyquote.com). Health care reform has brought professional chaplains to a place of chaos-a place that raises many questions about the past, present and future. This chaos presents tremendous opportunities for professional chaplains to increase their capacities in building intentional communities of learners by integrating faith, science, quality and systems thinking. Pastoral care givers must truly understand the pressures from all sides and the new emerging paradigm of integrated health care delivery. Without this understanding, we will not see the opportunities and challenges of integrating pastoral and spiritual care in the emerging structures and systems. The future of chaplaincy largely will depend on the quality of the data, quality of our conversations and our ability to thinking together through dialogue.     

Pastoral care personnel have prophetic role

Pastoral care ministers must look to the prophet's role in the Old and New Testaments to establish their own prophetic mission in health care facilities. After evaluating whether their own department acts justly, competently, and compassionately, pastoral care givers must hold themselves accountable to the signs of authentic prophecy: being motivated by love, being critical to promote constructive change, and being willing to confront others' resistance. Then the pastoral care team can begin collaborating with peers to provide a more healing environment for all staff and patients. This can be done by being available to help staff with problems, influencing policymaking, and using ministerial skills when giving sacramental care to patients. Pastoral care persons can link the facility to the outside community by finding ways to reach the needy and to address residents' unmet health needs. Eventually the pastoral care staff and their peers can work toward an active response to social justice. The challenge of being prophets requires pastoral care personnel to confront problems courageously and take advocacy positions while always showing compassion.     

Health Care Reform: Opportunities for Professional Chaplains to Build Intentional Communities of Learners by Integrating Faith,Science, Quality,and Systems Thinking

SUMMARY

Albert Einstein once said, “The significant problems we face cannot be solved at the same level of thinking we were at when we created them” (www.brainyquote.com). Health care reform has brought professional chaplains to a place of chaos–a place that raises many questions about the past, present and future. This chaos presents tremendous opportunities for professional chaplains to increase their capacities in building intentional communities of learners by integrating faith, science, quality and systems thinking. Pastoral care givers must truly understand the pressures from all sides and the new emerging paradigm of integrated health care delivery. Without this understanding, we will not see the opportunities and challenges of integrating pastoral and spiritual care in the emerging structures and systems. The future of chaplaincy largely will depend on the quality of the data, quality of our conversations and our ability to thinking together through dialogue.     

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.     

Pastoral care staff participate on treatment team

Clinical department members at Marianjoy Rehabilitation Center identified problems with their staffing conferences, in which they plan patient care. The problems included a deemphasis on social and spiritual aspects and an overemphasis on billing concerns. To correct these difficulties, the hospital adopted the Patient Evaluation Conference System (PECS), adding a pastoral care component. Central to the new system is the addition of pastoral care data from scales that assess patient status in four areas: (1) awareness of spiritual dimension of disability, (2) knowledge of spiritual resources, (3) skill in spiritual self-management, and (4) use of spiritual resources. Pastoral care staff write evaluations in easily understood language so other staff members can understand pastoral care's purpose. They formulate specific short-term objectives in order to delineate the pastoral services needed. Integration with the treatment team has resulted in greater accountability for the pastoral care staff. Patient progress charts now include specific pastoral care goals, and a daily report of pastoral care services is included on patient bills, although no fee is charged. Program evaluation and feedback systems to enable pastoral care staff to make more accurate assessments are planned. The new system has enhanced staff communication, service documentation, discharge planning, and the quality of pastoral care.     

Continuum of care comes full circle. Adding hospice care allows a Denver system to better meet patient needs

In November 1993 Hospice of Peace, a home hospice program in Denver, was reorganized under a new joint sponsorship of Provenant Health Partners and Catholic Charities and Community Services. Home hospice completes Provenant's continuum of healthcare. Based on the campus of Provenant Senior Life Center, Hospice of Peace employs multidisciplinary professionals who care for patients and their family care givers in their homes. Each hospice team works with a patient's physician and comes from a pool of primary care nurses, certified nurse assistants, social workers, counselors, pastoral care counselors, and specially trained volunteers and bereavement counselors. Respect for human life at all stages is the ethic behind the organizations' hospice efforts. Even at life's end, when aggressive medical treatment is no longer appropriate, healthcare professionals can enhance patients' quality of life and provide bereavement support to their loved ones. Just as Catholic healthcare addresses the spiritual component of healing, so it addresses the spiritual component of dying.     

Care of the dying: a Catholic perspective. Part III: Clinical context--good palliative care eases the dying process. Catholic Health Association

In the midst of a push for legalized euthanasia and assisted suicide in the United States, the Catholic healing tradition should provide good palliative care and support for dying patients. Catholic healthcare institutions can have a counterinfluence on the euthanasia movement if they strive to relieve all forms of pain-physical, psychological, social, and spiritual. Care givers must adapt their pain management methods to diverse groups of patients and their needs. Comprehensive pain management includes not only specialized clinical programs to control physical pain, but also counseling and human support to minimize psychological pain, community support groups to counter social pain, and pastoral care resources to address spiritual pain. Truthful communication lies at the heart of the therapeutic relationship. Healthcare institutions can likewise organize themselves internally to offer optimal support programs for those who are dying, their families, and their care givers. Necessary ingredients for a comprehensive approach include integrated treatment plans, hospitable environments, policies on advance directives and collaborative decision making, ethics committees that are well versed in end-of-life issues, education programs, and a hospice philosophy of care.     

Clinical Pastoral Education for Laity

Medical science, with its high technology, has had a major impact on today's hopitalized patient. Not only has the length of stay been shortened dramatically but the level of illness is much more intense. Both of these foactors have influenced the role pastoral care plays as a member of the health care. Carefully selected and trained laity can help meet the expanding pastoral care needs of hospitalized patients. This article describes a program designed exclusively for laity, which equips these volunteers through a clinical process similar to that of Clinical Pastoral Education (CPR). The authors contend that any program designed to prepare laity for passtoral care must include the clinical component. Their experience with 38 laity who have completed the program described in this article has led them to the conclusion that such a process inspires a dynamic growth in faith as laity claim their rightful authority in pastoral care.     

Care of the dying: a Catholic perspective. Part IV: Theological, moral, and pastoral response--the transformation of suffering. Catholic Health Association

People struggle to find meaning in suffering and death. In a culture that cannot depend on religious insights into suffering to address the deeper questions (e.g., Why me?), all kinds of interventions, even euthanasia and assisted suicide, may seem inevitable. Catholic healthcare providers can respond by offering patients, families, and care givers a vision of how suffering can be understood. Based on the power of divine love to transform suffering and death from absolute evils to personal triumphs, the moral principles the Catholic Church upholds can provide a hopeful perspective for healthcare professionals who care for the dying. Three principles support Roman Catholic teaching on conserving health and life: sanctity of life, God's dominion and human stewardship, and the prohibition against killing. These principles by themselves are insufficient as a moral or pastoral response to the care of the suffering and dying. Action is also required. Moral virtues must be reflected in ethical behavior and in pastoral practice so that we may enact our Christian vision in the face of suffering and death. Attention to our character as providers and our ethical practices is of grave importance in these days when euthanasia and assisted suicide are being promoted so aggressively. To carry on Jesus' healing mission by responding to human suffering and death, healing communities must embody virtues that bear convincing witness in both a personal and a corporate manner regarding the care of the dying. Three characteristics of a virtuous community stand out: interdependence, care, and hospitality. By being a virtuous community, we may be able to address many of the concerns that motivate people to consider euthanasia.(ABSTRACT TRUNCATED AT 250 WORDS)     

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.     

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.     

Fitness/wellness concept gaining. More hospitals creating affiliated centers

Celebration Health is envisioned as the prototype for healthcare delivery and enhancement for the new town. While Celebration Health is associated with a hospital, neither sickness nor hospitalization is the focus of the facility. It's a center that encourages Celebration residents and those of neighboring communities--even tourists--to take charge of their physical, emotional and spiritual well-being. Other companies are taking another approach to wellness. Because of a growing interest among healthcare administrators across the country in hospital affiliated wellness and fitness center business, The Benfield Group of St. Louis, Mo., has produced a 10-page booklet to help care givers arrive at crucial decisions. While some groups are forming informational publications. Community Health Center Management, which debuted with a July-August 1997 edition, was created to provide a source of information for community health center directors and health care providers.     

Spiritual care in Israel: the future is now

Spiritual care is a relatively new healthcare discipline in Israel. It has evolved over the past decade through the collaboration of multiple Israeli healthcare professionals, with assistance from interested professionals primarily from the US. The goal has been to create a spiritual care model unique to Israel. The study by Bentur et al. significantly contributes to the advancement of spiritual care in Israel by giving spiritual care providers valuable knowledge as to how the patients they care for cope with the existential and spiritual suffering of advanced illness. As the Israeli model of spiritual care is, to some degree, modeled after its counterpart in the US, this commentary compares and contrasts the two in the areas of: history, population demographics, acceptance by the healthcare system, and the available body of research. Recommendations are then presented as to how Israel, by mirroring the US experience, can create a spiritual care model that is unique to the specific needs of Israeli patients, while fostering its increased recognition as a fully integrated healthcare discipline in Israel.     

Safeguarding patients' dignity. The revised directives discuss spiritual and professional considerations

The Catholic health ministry recognizes that caring for the spiritual nature of a person is a high priority. The rights of patients and residents in their relationship with care givers are also important. These topics are treated in Parts 2 and 3, respectively, of the Ethical and Religious Directives for Catholic Health Services. This article focuses on those directives. Directive 10 says pastoral care should be available to all persons in a Catholic healthcare facility, no matter their religious affiliation. Directives 12 to 20 are concerned with the reception of the sacraments of baptism, penance, anointing, and communion by Catholics. Directive 21 discusses the appointment of priests and deacons to the pastoral care staff. Directive 23 reminds care givers that respect for human dignity must inform all Catholic healthcare. Directives 24 and 25 discuss norms for responding to advance directives and the responsibilities of surrogates. Directives 26 to 28 are concerned with free and informed consent on the part of patients and surrogates. Directives 29 to 30 say care givers have a moral obligation to preserve a patient's anatomical and functional integrity. Directive 31 discusses the ethical limits on medical research, and Directive 33 discusses therapeutic procedures likely to harm the patient. Directive 34 says care givers must protect patients' privacy. Directive 36 discusses the care of women who have been raped, including treatment that would prevent ovulation as a result of the rape. Directive 37 says ethical consultation should be available to all Catholic facilities, usually through an ethics committee.     

Ministering to persons who face death. Practical guidance for care givers of persons making end-of-life treatment decisions

It is time care givers learn how to minister effectively and sensitively to those making end-of-life treatment decisions. To do so, care givers need to be aware of the various meanings death and dying hold. Culture, religion, past experiences with death and dying, and current situations can all influence the way persons perceive death and dying. Sensitivity to who the patient and family are, to how they perceive the disease or illness, and to how this perception influences their ability to achieve their life goals is a critical care-giving skill. Sensitivity, however, need not result in value neutrality or tolerance. Care givers should not be mindless executors of patient or family demands. Care givers must learn to talk honestly with patients and families about how a particular disease is most likely to progress and about the types of decisions they are likely to need to make. And then care givers need to present options, remaining sensitive to the patients' beliefs, values, and interests. Persons who care for the dying will face three types of patients, who will require different types of responses. The three types are patients who welcome death, patients who accept death, and patients who fight death. For all types of patients, care givers must keep the care patient centered and responsive to patients' priorities; facilitate informed decision making; promote communication among the patient, family, and healthcare team; support autonomous decision making; mediate conflicts; and offer spiritual counseling.     

Toward a just healthcare system

The U.S. healthcare delivery system is a patchwork nonsystem full of inequities, whose symptoms include the prolongation of the dying process, a lack of preventive care, and patient dumping. What can be done to make this nation's healthcare delivery system more just? The U.S. healthcare system should be modeled on the same underlying assumptions and justice-related values as the U.S. education system, a system based on need. Americans would find such a model psychologically acceptable because they are familiar with it, even though it is not perfect. Because they have the facilities and resources at their disposal, care givers must experience solidarity with all those who need care. The unity and solidarity of all creation is an explicitly Christian theme and is an appropriate value to emphasize with regard to compassionate healthcare. To establish a fairer healthcare delivery system, providers must consider their own Christian responsibilities and those of the Church, as well as the civic responsibilities of the government. If Catholic healthcare professionals do their part to change the status quo, Americans will be able to enjoy a fair system of healthcare delivery based on need, not on ability to pay.     

The modern CIO: forging a new role in the managed care era

The advent of managed care has helped forge new roles for healthcare professionals. Competitive pressures, the profile of the member community, and provider network design drive healthcare delivery via the managed care model. Careful analysis and design of the managed care model charts the success or failure of the health care delivery system--usually an integrated delivery system (IDS). Therefore, those healthcare organizations that have chosen to get on the managed care bandwagon must re-invent themselves, both culturally and technologically. The chief information officer (CIO) leads this technological revolution. To work effectively, the technological infrastructure of the IDS must be closely in line with enterprise goals and objectives. In the managed care environment the old information system (IS) approach of supporting the operational needs of individual departments simply will not work. The CIO's new role will be to master the concept of managed care to ensure that enterprise-wide needs for operational, clinical, and financial information are met, and that IS and enterprise goals are aligned. CIOs who have an intuitive grasp of the managed care environment--although their numbers are growing as managed care mushrooms--make up a minority group. They are a special breed with clearly definable qualities such as business savvy and an affinity for big-picture thinking. To an IDS, a CIO with these qualities is a rare gem indeed. This article introduces Don Winschel, the associate administrator and CIO of Johnson City Medical Center (Johnson City, TN) as an example of one such modern CIO.     

The place of spirituality in managed care. Attending to spiritual needs can help managed care systems achieve their goals

If managed care leaders are able to achieve their goals of enhancing total well-being within a capitated system of care, they must attend to the broad new societal interest in spiritual perspectives and find ways to integrate them into their structure of care. Imaginative and sensitive members of many professions, particularly those who acknowledge the value of spirituality in their own lives and are convinced of its value in healing, will likely spearhead this integrated movement. Promoting individuals' total well-being necessitates an acknowledgement that everyone has a unique personal spirituality that needs to be addressed at times of crisis, such as illness or hospitalization. Further, attention to the spiritual dimensions of problems that result in high healthcare costs, such as violence, alcoholism, and the fear of death, can help reduce those costs. The process of grief also needs to be addressed in healthcare settings, for professionals as well as patients, to enhance understanding, acceptance, and the quality of care. People recover and retain health through a balanced integration of physical, spiritual, and community aspects of their lives. If professional chaplains who have emphasized crisis and acute care in their ministry styles are to contribute to this integrative healing and its adoption into managed care systems, they may need to explore broader frameworks, holistic concepts of healing processes, motivations for self-care, and a personal holistic balance.     

The Chaplain/Pastoral Counselor as a Behavioral Medicine Consultant in Cardiac Rehabilitation

Pastoral Behavioral Medicine Consultants can make a valuable contribution to the modern hospital particularly if physicians and other health care professionals are joined in offering creative and effective programs for healing. This article discusses several programs in which the traditional hospital chaplain's role is extended to that of a pastoral/behavioral medicine consultant (PBMC). The examples are meant to stimulate the reader's interest, ideas and intuition about innovative ways that the modern PBMC can not only survive but flourish in chaplain/pastoral counseling ministries.