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.

Wednesday, November 14, 2012

New Resources for Episcopal Wonks

I have referred a number of times to great stuff one can find on line through the Digital Archives of the Episcopal Church. It's where I've found past Resolutions of General Convention and Actions of the Executive Council. Well, now there's a whole new resource there: the Reports to General Convention (better known as the Blue Book) for Conventions dating back to 1976.

What can you find there? Between Conventions there are a variety of groups who meet to carry forward the priorities set by each Convention. They are the Commissions, Committees, Agencies, and Boards (CCAB's) of the Church - some under the jurisdiction of General Convention itself, some of the Executive Council, and some of one or both of the Houses of Deputies and of Bishops (often referred to as the "Interim Bodies"). Each Interim Body reports to the next General Convention on its work. Part of those reports may be specific resolutions to General Convention (the "A" resolutions). However, each report also gives discussion, reflection, and rationale for the work and priorities of the Church. So, each report gives a window into the thinking within the Church on a given issue. To make matters easier, the good archivists separated out each report. So, you don't have to open up a 400+ page Blue Book. You can link to a specific report.

Now, sometimes you'll have to dig a little to see which body had responsibility for a particular topic. Some bodies have changed their names over time, and some have been added. However, each document is searchable. 

So, if you want to know what has been said to the General Convention on a topic, often by some of the best minds in the Episcopal Church, this is the place to look. It offers a depth and perspective on many issues that you won't get just looking at a resolution. And since these reports are received by General Convention, they will show for each Convention the best work for the time, if not necessarily the official statements (which resolutions would), often by some of our best minds.

So, go dive in. You'll be amazed (and perhaps sometimes appalled) by what you find.

Thursday, November 08, 2012

Reflection for the Day 11-8-2012

A woman stopped me in a parking lot this morning. She wanted money for gas. I gave her some. She wanted a little more "for milk for the children." I gave her a little more.

I had two concerns that were both in my mind. One was whether I'd actually done her good. I couldn't know whether she would use the money well or poorly. I might be sustaining a vicious habit, ultimately harming her. Sometimes, we're told, better to say no and press the person to seek help from an agency that can provide access to more resources. So, one thought was to wonder whether I was helping or harming her.

The second thought was whether in the process I'd been cheerful enough.