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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