Wednesday, November 28, 2012

Standards of Practice for Chaplain: Standard 1, Part A

I know it’s been a while. Bear with me.

Many of the professions involved in health care have long had Standards of Practice. For example, you can learn about nursing standards here; or about social workers here.

In 2009 a group  with representatives from the Association of Professional Chaplains (APC) and the National Association of Catholic Chaplains (NACC) produced a set of Standards of Practice for Chaplains in Acute Care (which is to say, in hospital settings). You can learn more about that process and access the Standards here.  The Standards may have several benefits for us in the profession.

Having Standards of Practice will now help chaplains communicate with others about chaplaincy and assist chaplains in discussions with other chaplains. Ultimately, the goal is to ensure a consistently high clinical practice for our profession.

With these goals in mind, my department is embracing these Standards of Practice. Over time they should become the framework for our work, and the way that we “tell our story” to other chaplains and to administrators.

That means I need to be thinking through these Standards myself. I need to be able to speak to them if I’m going to help others embrace them; and one of my most effective ways to think is to think out loud here.

The Standards are divided into three sections. Section 1 is Chaplaincy Care with Patients and Families. The sections begin with “Standard 1, Assessment: The chaplain gathers and evaluates relevant data pertinent to the patient’s situation and/or bio-psycho-social-spiritual/religious health.”

As I look at the Standard, the first issue has to be definition of terms. For me, the hardest isn’t really the strangest. “Bio-psycho-social-spiritual/religious health” is simply – no, let’s just say really – a jargonistic way to speak to the health of the whole person, incorporating an expectation that a person who is holistically healthy is spiritually healthy.

No, I’m much more concerned first about “relevant data pertinent to the patient’s situation….” What are we considering data?

One of the older documentation frameworks, used in many cases in Social Work and also sometimes by chaplains, is the classic SOAP note: Subjective, Objective, Assessment, Plan. The categories that are about data are Subjective and Objective: what are the statements the person can make based on perception (Subjective – like “Patient appears anxious”); and what are the statements that others would also see as facts (Objective – like “Patient is holding a rosary”). Both the subjective and objective statements are data; and by identifying some as “subjective” and some as “objective” there is some acknowledgement of differences of authority.

So, for chaplains, what might we consider data? What we perceive, certainly; and what is reported. For example, both what we have in the present moment can inform us, and also what stories we hear from patients and family members. A patient’s statement about church membership is data, and so is the patient’s story about a childhood experience in Sunday School.

Which confronts us with the qualifying term: what makes the data relevant? Actually, the Standard is to evaluate the data for relevance. Our models for evaluation are the frameworks within which we determine whether the data is relevant. So, let me think a bit and then come back in the next reflection.

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