Renewal at the Episcopal Café

I wanted to invite my readers to take a look again at the Episcopal Café. The Café has been moved to a new host and server, with new leadership. The look is very different.

At the same time, the intent is the same: to reflect important news for and some of the best thinking in the Episcopal Church today. The format looks different, and some of the categories have been combined. To get a better feel, you might look at a couple of articles talking about transition to the new site.

I have had one realization. Some of my earlier links to articles at the Café work and some don't. It may take some time to sort those out. At this point, too, it isn't possible to search the new site. There is hope that it will come.

One way or another, it is still worth reading and reviewing. Take a look at the Café, and at some of the interesting - and, yes, exciting - things that people want to showcase about and for the Episcopal Church. It certainly looks new, but it remains worth our time and attention.

Another Great Resource for Chaplains - and For Religion Nerds of All Types

My regular readers will know that I am something of a nerd. I work in a research environment. I grew up in a research household. So, I can get a real rush just from seeing and thinking about an interesting article title.

So, I want to share with you a resource that just tickles the nerd in me like nothing else. There is an organization called the Institute for the Bio-Cultural Study of Religion. According to their web site,

IBCSR's mission is three-fold, involving research, training, and outreach.Research: IBCSR aims to conduct leading-edge research into the biological and cultural foundations and functions of religion.Training: IBCSR aims to train researchers in the bio-cultural study of religion at the very highest level.Outreach: IBCSR aims to reach out to researchers, scholars, and the general public to build professional networks and to share information about the bio-cultural study of religion.Also, the core values of IBCSR's institutional identity include the following:

• maintaining the highest intellectual standards in all phases of our work;

• acting ethically toward our business partners and funding sources;

• maintaining neutrality regarding the ideological promotion or critique of religious traditions, faith communities, and political outlooks; and

• remaining institutionally agile, with minimal institutional overhead.

From their web site, one can subscribe to the monthly IBSCR Research Review. It comes with pages and pages of citations of published research and abstracts, all published in the previous calendar month. With that and access to a good library, there's a wealth of information. Beyond general interest in the academic study of religion, there are large sections dedicated to research relevant to Religion and Health. For chaplains and others, the articles can be of real value. Best of all, the IRR is free! 

So, take a look at the web site, and think about subscribing. This can be an exciting resource for all of us interested in research on religion, and especially those of us working in  settings where research is the currency of the realm

A Poem Today: 10-24-14

The Pelican

The pelican on the piling,

Grey and brown in the sunlight,

Gazes over the water. 

It is and is not his home. 

In it he finds, 

From it he takes, 

The fish that sustain him and his. 

On it he finds,

Over it he rides,

The thermals that lift up him and his. 

On it he rests. 

In it he dives. 

It is and is not his home. 

But there on the piling he gazes, 

And to the sun he turns

And opens his wings,

Taking in the warmth,

Taking in the strength 

I spread my arms to the sun 

Wings heavier and weaker than his,

To feel the warmth,

To feel the strength. 

Illumine me this day

That I may find what I need

That I may be lifted up

That I may find rest

On the water

That is and is not my home. 

The Chaplain on the TREC: What I'd Like to Hear

I have been thinking about the work of the Task Force to Re-imagine the Episcopal Church (TREC). I've been more aware of that more since the last Report and the gathering, and the many responses. I've had two issues rise for me, issues that are separable but related. 

Almost all the discussion has focused on issues of power and authority. That's relevant, of course. At the same time, it speaks to a climate of fear: will I, will we be disadvantaged? 

However, it is not the most important issue for me. I am more compelled by the section of the Report that speaks to function. The Task Force is correct that ministry happens primarily at the parish. As a chaplain I often remind colleagues that the normative experience of the Christian is not at the hospital bedside but in the congregation. So, I'm excited at the thought of the Episcopal Church Center or whatever overarching structures we have as catalytic and connecting and communicating of parish

ministries. In all the conversation there seems to me to have been too little reflection on this, even positive. Perhaps it's so widely accepted that no one sees a need to comment. 

To do that, the Task Force suggests that more be done through networks, and that concerns me. I work in a corporate environment and I am as aware as the members of the Task Force that everyone is talking about dispersed authority working in networks. At the same time, there are networks and the there are networks. I think that before we embrace that we need more conversation about what the network would look like that would connect and communicate the ministries and the catalytic ideas. I think that is part of what we need from the Task Force. 

Let me say more. I have a lot of experience with networks, and I'm conscious of important differences. For example, most of my readers know that I'm a member and past president of the Assembly of Episcopal Healthcare Chaplains (AEHC). AEHC is a voluntary professional membership organization supporting healthcare chaplaincy in the Episcopal Church - which is to say a network. I am committed to AEHC and to being a chaplain among the Episcopalians. I am also conscious of its limitations. Member organizations as networks are dependent on the time, energy, and availability of members. They are especially dependent on those members who volunteer to be leaders and officers. Of course, the officers and all the members have limited time, energy, and availability. That limits what connection and communication can happen. Of course, that also means they have limited memory. As a result, the same issues come back into conversation as if they were new. Sometimes they do look new because the circumstances around us have changed. But we discover on reflection that the basic issues, like the classic heresies, rise up again and again. Changing leadership means a risk (although not inevitable) of loss of institutional memory. 

By the same token, there is difficulty in catalysis. With limited time and energy there is limited connection and communication, and ideas don't get shared. Basically, the network has too little and too weak a center to sustain programs of ministry. They can support some personal connection and advocacy, and those are valuable. On the other hand, I think the Task Force expressed higher expectations. 

In a different model, I spend time on the networks Facebook and LinkedIn. Those  networks demonstrate an interesting paradox. They appear chaotic. That is, individuals and groups find them decent tools for various efforts. In that sense these can be useful tools. At the same time, it is only a tool and each of those individuals and groups has disparate purposes. 

The paradox is that these networks in fact have coherent purposes: to make a profit by providing a service. As chaotic as they can seem to users, they have clear centers of authority and power. They have ongoing experts who have institutional memory and carry through on the central goal. In fact they are largely invisible until they change the environment. We don't see them until they change security parameters or give us a new capacity that we didn't ask for. Those networks have a lot of disparate activity, but they don't really have dispersed authority. Moreover, that authority is hidden and not really accountable to the users. I'm not saying they are not useful tools; but as networks I don't think they are models we want to follow, especially with all the anxiety we're expressing about centralized power. 

Then there are the Information Technology networks in corporations like the one I work in. I have a great relationship with the IT folks in our system. They do great work. They have a commitment to a central mission and clear (and even somewhat dispersed) authority. They understand that the network is a tool and not an end in itself. On the other hand, they are neither volunteers nor amateurs. They are also not cheap nor self-funding. 

All of these are networks. Each has its strengths and it's limitations. None of them seems to me what TREC is talking about, exactly. So, I don't think we've talked enough about that. I think we need to have that conversation before General Convention, and I think TREC needs to lead it.   

Again, I know that there has been more said and asked about power. I have other thoughts about that. I do think, though, that if we don't have the conversation about our expectations of networks we'll discover that those concerns get shaped not by our ministries but by the needs of the tools themselves. 

If we're serious about re-imagining the Church, the questions of structures and tools are important. That is what I'd really like TREC to lead us in now. 

On Gourd Vines and Wages and Mercy: Sermon for Proper 20A

It's taken me a couple of weeks to get back to it, but on September 21st I preached again at St. Mary Magdalene Episcopal Church. There was something there about expectations, and about God's mercy, and even an important reference to Blessed Janis of Texas. You can hear it here. I hope you find it moving.

On Being Free in Christ; and What It Isn't. Sermon on Proper 7, Year A

In looking back through the sermons I've preached at St. Mary Magdalene, I realized that I hadn't posted my sermon of June 22. It was about Romans 6, and Paul on freedom from sin. Of course, what Paul wrote about freedom might mean something different from what we might expect.

Who is That Troublesome Woman? A Sermon on Propers 15, Year A

I had the privilege of preaching again today at St. Mary Magdalene Episcopal Church. I found myself preaching on a troublesome woman, and on troublesome wrestling about faith. I hope you find it meaningful.

Well Worth Reading

Normally, siblings, when I point to something at Episcopal Cafe it's something of mine. Today, though, I want to point to someone else. I want to encourage my readers to read this post by Maria Evans. We often talk about what it might mean to give one's life for another. This, I think, adds an interesting example of what that might look like.

Maria is an Episcopalian and a pathologist who blogs at Kirkepiscatoid. She's an honored colleague at the Cafe; and when you this (and, hopefully, other posts of hers) you'll know why.

My Yoke Is Easy: Reflections on Proper 9, Year A

This past Sunday I preached again at St. Mary Magdalene Church. They are normally gracious to record my sermons. Unfortunately, there was a power surge and the recording was lost. This isn't exactly the sermon I preached; but it is substantially the sermon.

Coming up to the beginning of Chapter 7 of Romans, Paul has been working to describe life in Christ. Critically, in Chapter 6 he made clear that when he talked about freedom from sin, he wasn’t talking about our contemporary idea of freedom: the latitude for the individual to choose his or her actions without accountability. Rather, he was clear that to be in Christ is to be free from the dominion of sin, accountability to and for sin, because one was a servant of Christ, under the dominion and accountability of Christ.

At that point, he ran into human nature and limitedness: "I do not understand my own actions. For I do not do what I want to do, but I do the very thing I hate." He felt himself trapped in a failing he couldn’t control – what he identified as "a law that when I want to do good, evil lies close at hand." His frustration rose until he cried out, "Wretched man that I am! Who will rescue me from this body of death?" And his answer: "Thanks be to God through Jesus Christ our Lord!"

Now, we don’t need to think too hard about this, because it’s our own all too common experience. Sometimes it’s not a matter of intent, but just of the limitations of the world. We have a new puppy in our home. She has decided either that I’m the best toy, or that I’m the Big Dog; but one way or another she wants to play hard and test herself against me. She’ll come at me in mock attack as she would at another puppy, and I will push her away. As she comes back again and again she gets more and more excited, and sounds like some vicious creature. In fact, she doesn’t try to hurt me, even as she comes at me mouth open and teeth bared. She doesn’t try to bite, really, but those puppy teeth are really sharp. So, I get scratched and I bleed. It isn’t wicked intent at all, but I get hurt anyway.

Sometimes it is about wrong intent. When I was in Eighth Grade there was a day in my math class that I saw an opportunity. I was never all that good at algebra, even in those first steps. I was never all that popular, either. So, when I saw that my teacher had made a mistake in the third step of an eight step solution I saw the chance to look smart, and to look cool to my classmates by showing up the teacher. Now, the teacher was a nice man. He was short in stature, and is sometimes the case, he was defensive about it. He was shorter than most of the boys in class – shorter, even, than most of the girls – and had something of an attitude in reaction. So, as I pointed out the mistake, and then walked through correcting the remainder of the solution, I did feel the class beginning to chuckle at the teacher’s discomfort. But that sense of pride became ashes in my mouth as I watched the man cringe, and seem even to visibly shrink. I had started with goals I thought harmless, and realized that I had done harm.

We are grateful, of course, for Paul’s response: "Thanks be to God through Jesus Christ our Lord!" At the same time, that doesn’t tell us a lot about what that looks like, actually lived out in our lives. But, then, that’s what Jesus was talking about in the Gospel lesson from Matthew 11. More to the point, he was beginning with the fact that people’s preconceptions can keep them from seeing how God might be working among them.

 

Jesus said to the crowd, "To what will I compare this generation? It is like children sitting in the marketplaces and calling to one another,

`We played the flute for you, and you did not dance;
we wailed, and you did not mourn.'

For John came neither eating nor drinking, and they say, `He has a demon'; the Son of Man came eating and drinking, and they say, `Look, a glutton and a drunkard, a friend of tax collectors and sinners!' Yet wisdom is vindicated by her deeds."

Because they were looking for something particular, they weren’t able to see God working around them, whether in John or in Jesus.

This was a problem, too, because in the last few weeks’ Gospel lessons Jesus was sharing about discipleship, and how it was expected to be difficult. It would not be what was expected, and would not be easy. And yet he said, "Come to me, all you that are weary and are carrying heavy burdens, and I will give you rest. Take my yoke upon you, and learn from me; for I am gentle and humble in heart, and you will find rest for your souls. For my yoke is easy, and my burden is light." If discipleship would not be easy, what could it mean that "my yoke is easy?"

I read a number of comments about that, and one that caught my attention was that "easy" isn’t really the best translation of the Greek. The word translated "easy" might be better translated "appropriate" or "well-fitted." Then I started reading about working with oxen - as in

 

Oh, don’t you remember sweet Betsy from Pike
Who crossed the green mountains with her lover Ike,
With two yoke of oxen and one spotted hog,
A tall Shanghai rooster and an old yeller dog.

I started looking at images of oxen yoked, and I noted that there are almost always two yoked together. It isn’t that you can’t yoke one ox, but almost all the images I found were of two oxen yoked together. I wondered about how one got them to work together.

Now, I admit that I’m a city kid. I may spend a good deal of time gardening, but I’m not a farm kid, and I don’t know about training oxen. On the other hand, I do a little something about training elephants. At least, this one I got to hear from the folks who actually did it. When I was seventeen I spent a summer in Sri Lanka, and had the chance to visit with elephants who had been domesticated, and with their trainers. Of course, there are elephants raised in captivity, and their training isn’t the same. But when a wild elephant is captured, first it is isolated until it becomes used to the human beings around. Then, to train it to work it is tied to an older, trained elephant. So, it literally learns the tasks required of it by being there as the trained elephant carries out its duties. The new elephant learns from the elephant to which it is yoked.

That got me to thinking about Jesus calling us as disciples to take his yoke. Certainly, it is a call to vocation, to work; and he promises that the yoke will be properly fitted, with no chafing. But, again, I found myself wondering who was on the other side of the yoke. Jesus called it "My yoke." What if that meant that the other person "yoked" to us was Jesus? What if it wasn’t just Jesus’ yoke because he fitted it to us and walked alongside us giving commands? What if it was Jesus’ yoke because it was the yoke he himself shared with us? That would certainly make sense of how the work, the burden, might be light; for he would be pulling with us, sharing with us in the load.

Jesus calls us to vocation. We struggle with how to live out that vocation, and not least with the realization that whatever our best efforts, we fall short and do, not what we know is best, but something less – and that’s when we do make our best efforts. But what if our vocation is not simply about task, but about formation? What if we are called to work sharing Jesus’ yoke, properly fitted to us, with Jesus? What if he calls it his yoke because he shares with us and shapes us in our discipleship because it is he who shares the yoke and the load with us? That would, I think, put a very different and a very hopeful understanding of what he meant when he said, "Take my yoke upon you, and learn from me; for I am gentle and humble in heart, and you will find rest for your souls." For his yoke is properly fitted to us, and our burden, shared with him, it becomes light.

　

　

On Hearing and Being Heard; On Getting Beyond Not Losing

My newest piece is up today at the Episcopal Cafe. It began as reflection on not being heard, and on being heard but not convincing. As usual, it didn't end there. I hope you'll take the time to go look.

And, as I always recommend, while you're at the Cafe, look around. There are interesting news items and interesting essays, reflecting some of the most thoughtful folks in the Episcopal Church (and me, too!). Look around, leave a comment, and become part of the conversation.

Preaching the Sunday after Ascencion

My sermon from this past Sunday is now available at the web site of St. Mary Magdalene Episcopal Church. I found myself thinking about an important question from the description in Acts of the Ascension. I hope you enjoy it.

Easter Symbols at Episcopal Cafe

My newest piece is up this morning at the Episcopal Cafe. It is a flowery piece - and I don't mean that the language is especially formal. I'll let you discover what I mean. Go over and take a look.

And as always I recommend spending some time at the Cafe, browsing news and information and some excellent essays, reflecting some of the best of the Episcopal Church. Come, read, and comment. Those of us at the Cafe want to hear what you might have to say.

Catching Up a Bit More

I was also at St. Mary Magdalene Church for a joyful Easter Vigil and Eucharist of the Resurrection. That sermon is now available. You can listen to it here. (Yes, I know it seems to have taken some time; but, then, Easter is all of 50 days!)

A Bit of Catching Up

Well, Holy Week and Easter have passed, and I have been on vacation. I have now had a bit of a chance to catch up. So, I preached Palm Sunday at St. Mary Magdalene Episcopal Church at Loch Lloyd, Missouri. If you'd like, you can listen here. It's shorter than usual -  but, then, after the Long Gospel (in this year, from Matthew), one shouldn't need to say a lot more.

Seeking the Right Thing: a Reflection for Holy Week

Sometimes I wonder whether sometimes we go looking for the wrong thing. I have noted recently stories about 'Charlotte's Web.' In this case the subject is isn't the wonderful children's book or related works. In this case, 'Charlotte's Web' is a medicine derived from hemp. I say 'hemp' advisedly. We're not talking about marijuana - or, well, not exactly.　

'Charlotte's Web' has been the news because it has been remarkably helpful for children with seizure disorders that haven't responded to other treatments. News stories have reported about the treatment in Colorado since that state approved medical marijuana, and about efforts in Florida to get it legalized there.

Part of what is interesting to me is that the active ingredient in 'Charlotte's Web' isn't THC, the substance that gives the high. Instead, it is cannabidiol, or CBD. In fact, the strain of hemp developed to produce high quantities of CBD is low in THC.

Now, over the years part of the controversy about medical marijuana has been whether we can identify medical uses for THC. In fact pharmaceutical THC does exist and does get tested. But, what if we're looking for the wrong thing? What if we're looking at medical marijuana and at THC because we've enjoyed the high, when the effective ingredient is CBD?　

Let's remember that this happens with some frequency. One of my favorite television series of past years was 'Connections.' In that series from the late 70's James Burke traced through history scientific and technological developments that had interesting results, but rarely those that were expected or sought. For example, the IBM punch card familiar to those of us of a certain age had its roots in the French weaving industry.

So, what if we're looking for the wrong thing? We do that often enough in the Church. Historically (not to cast aspersions on current activities), we've often had Commissions on Ministry that were really Commissions on　Ordained Ministries. Someone who didn't quite fit as deacon or priest didn't necessarily get good guidance - or any meaningful guidance at all. Congregations in transition have often sought to replicate someone from the past, not thinking about of the needs of the future.　

We do that personally as well. We have a romantic view of what love is about - we seem to think first and mostly of 'romantic love' said there were no other - and find ourselves failed and failing. In survey after survey we say of government, 'Throw the bums out,' and then keep electing incumbent who caters to our self-serving positions.

And in none of these cases are the things we seek 'wrong' necessarily. That is, they aren't 　inherently immoral. At the same time, they aren't the right things for the needs and circumstances we face. They are what we want, but not what we need.　

We look for the wrong things in Easter. At least, I think we can get distracted by the wrong things about Easter. We talk about being freed from death who no longer see death as a daily reality. We talk about being freed from sin when we have no sense of sins to confess. We can relish the joy of Easter as if we didn't have to go through Good Friday to get there.

Do I overstate? Perhaps I do. Certainly, I do think we liturgical types, Episcopal and others, have more opportunity to embrace the aspects of our faith that we need and don't necessarily want. Let me also affirm that we are also looking for the wrong thing if we wallow in the guilt of Holy Week and never claim resurrection.　Still, the quasi-Christian culture around us jumps happily to flowers and bunnies and chick and children with candy eggs, as if all that new life had come without hard experience – flowers that must break the soil; children and their mothers who survive childbirth.

That same culture in political speech will remind us that "freedom isn’t free," and will recall faithfully those "who made the ultimate sacrifice." How much more appropriate, then, that as we celebrate our joy in Easter that we recall that it has come indeed at the cost of the ultimate sacrifice – ultimate not only in the extent of Christ’s commitment, but also in the extent of God’s consequences. Our graves will only open because he experienced the grave first. And so, let us not be distracted, jumping ahead and seeking the wrong thing. Rather, let us prepare to celebrate the Paschal Feast by embracing wholeheartedly the Way of the Cross.

Chaplains Need to See This

PlainViews, the on line journal for chaplains, is a resource I have mentioned before. It's in the sidebar of this blog because its information is worthwhile. The one limitation is that it is a subscription journal, and so most articles are behind the pay wall.

The newest edition has come out, and this edition is open access. That is, all the articles are available to anyone. That's important, because the topic of this edition is recent conference, "Caring for the Human Spirit: Driving the Research Agenda for Spiritual Care in Health Care." The articles in this edition of PlainViews reflect the presentations at the conference, and offer a number of interesting recent research studies about how chaplains work and how patients and caregivers benefit. So, I would encourage chaplain colleagues (and, really, anyone else who's interested) to take advantage of this open access edition. See what others are doing to study how we work and how patients, families, staff members are served. There's a lot here for us to think about.

New at the Cafe

In addition to getting cranked up here again, I'm back at the Episcopal Cafe. My latest, a reflection on employee evaluation as Lenten discipline, is up now. Go take a look; and if you like, leave a comment, either here or there.

I continue to think that the Episcopal Cafe offers some of the best thought and reflection, and some of the most interesting information, coming from the Episcopal Church. I hope you'll take some time there, not just for what I write, but for what so many offer.

Thinking About Who Pays

So, I have been aware today of the case before the Supreme Court of the owners of the Hobby Lobby retail chain resisting a provision of the Affordable Care Act intended to insure access for women to all forms of birth control by requiring that employers either include that in company-sponsored health insurance plans or pay a penalty that would allow then allow women to pursue in the insurance exchanges health insurance plans that would cover birth control. There have been many reports about it; and regular readers will know that I listened to the report this morning on NPR.

 

I wasn’t paying too much attention, largely because I wasn’t hearing much new. After all, this has been a topic of discussion for a while. Then I heard this:

　

"The Hobby Lobby corporation and its owners counter that the simple answer to these arguments is to have the government pay for contraception.

The government replies that is no answer. Otherwise, the government would end up paying for everything. A decision is expected by summer."

　

I found myself wondering something more profound in this idea that if the government wanted to mandate health care, the government should pay for it – something I doubt the Greens or their attorneys thought about when they made that statement (if they made it as reported). That is, if this applies to birth control then it should also apply to therapeutic abortion.

　

First, let me take on directly what I mean by "therapeutic abortion." There are cases (and perhaps not so rare) when terminating a pregnancy is medically appropriate. Think, for example, of the woman a few years ago in Phoenix. She was diagnosed with pulmonary hypertension in the eleventh week of pregnancy. While the case was reported because it was complicated for religious reasons (she was a patient in a Roman Catholic hospital), under court decisions and state laws terminating the pregnancy was appropriate because it was literally to save the life of the mother. In fact even the hospital saw it that way, and terminated the pregnancy. The controversy and news coverage came because of the reaction after the fact of the local Roman Catholic bishop, not because the woman didn’t get the care.

 

So, I’m not talking about "abortion on demand." I do think that terminating a pregnancy ought to be a decision a women makes with her doctor; that there ought to be a supportive family and community for that woman; and that the procedure needs to be available and safe. But, for this post I’m only talking about situations that are clearly medically indicated. The one I cited above was rare and rather spectacular. More common are situations like loss of amniotic fluid mid-pregnancy that doom the fetus and put the woman at severe risk. Sure, these aren’t common, but they do happen. And women die. According to the Centers for Disease Control, in 2009 the rate of pregnancy-related deaths was almost 18 per 100,000 live births. That comes to about 650 women each year; and while that may not sound like many over all, say that to the families of those 650 women.

So, by the logic stated above, the government ought to pay for therapeutic abortions. Of course, that brings us up against the other perspective: those who say "no government money" for abortion, including Medicaid dollars. And then, of course, there’s this problem with the logic: those who would refuse to support birth control in the insurance plans offered by the companies they own would then be supporting birth control in the tax-supported insurance plans and/or direct purchases – because to say "let the government support it" is to say, "let all the taxpayers support it – including us."

My guess is that the Greens’ attorneys have a much more sophisticated way of stating that idea that the news report may not do justice. However, the principle as stated caught my attention. It has possible consequences that seem directly contrary to the results the Greens want to see. Call it another of those unforeseen, but perhaps predictable, medical outcomes.

Working on Visibility

Well, not me, really. I've been pretty quiet for a while now, and I'm working on getting back into gear. In the meantime, we're working on making the Assembly of Episcopal Healthcare Chaplains (AEHC) more visible. To that end, there is now an AEHC Facebook Page. This will give us more visibility for those already on Facebook, and a way to share our story. It will also give us visibility beyond Facebook because Facebook Pages are searchable, and will pop up in Google, etc. We'll have a way to connect with new folks, and to hear from supporters across the Church and beyond.

In time, we'll also have a Facebook Group. We'll use that for conversation and discussion. While we work on that, please share with friends and colleagues about our new outlet. Take a look and add your comments. Let's use this to make more and more folks aware of the healthcare chaplains in the Episcopal Church.

Standards of Practice for Chaplains: Standard 3, Part B

This is a continuation of my reflections on the Standards of Practice for Professional Chaplains in Acute Care. If you are interested, you can access Standards and related information from this page. You can find my earlier posts on this subject by clicking on the link for Standards of Practice under the Label menu in the sidebar.

I ended my last post focused on examples in the explanation of Section 1, Standard 3 Documentation. I was thinking about principles of the Standard that I suggested might be necessary but not sufficient:
 

Documentation should include but is not limited to the following:

• Spiritual/religious preference and desire for or refusal of on-going chaplaincy care. Reason for encounter.
• Critical elements of spiritual/religious assessment .
• Patient's desired outcome with regard to care plan.
• Chaplain's plan of care relevant to patient/family goals.
• Indication of referrals made by chaplain on behalf of patient/family.
• Relevant outcomes resulting from chaplain's intervention.

My questions were, first, whether these principles were really those we would focus on; and second, how our tools for documentation would affect our efforts at documentation. Let me begin with my first question.

 
Let me begin with a note about how these principles contribute to the explanation. They can shape our thoughts, our plans. At the same time, they are neither the Criteria of Measurement, nor are they among the Examples. They are to help us think, to help us plan; but in one sense they are "neither fur nor feather, neither fish nor fowl." The thing is, though, that we must avoid getting too hung up about these words – indeed, about any of the words, including the Criteria of Measurement and the Examples. The Standards of Practice are works in progress, and subject to revision over time. Lived experience should over time shape these Standards. So, in considering any of these words, these concepts, we can remember that they are to help us think and talk more than they are to become "the law of the Medes and the Persians that cannot be changed." So, the real question is how these principles and criteria and examples can be useful for us, and not how can we fit our work into these parameters.
 
So, in asking whether these principles are the ones we want to live with, we have room to discuss how we might use them. One stands out to me. While I can readily see the importance of spiritual/religious preference, I wonder whether "desire for or refusal of on-going chaplaincy care" should be necessary. First and foremost, is that a matter that will come out of an authentic conversation? We might hear that; or we might elicit it with a question; but we might not. Further, it presupposes that the patient has a clear understanding his or her own needs or that the patient has a clear sense of all a chaplain has to offer. Also, pairing follow-up care with spiritual/religious preference appears to presuppose that the chaplain's work will be valued more by those who have a preference than by those who don't.
 
I could raise a related question about "Patient's desired outcome with regard to care plan." If we are professionals with a body of knowledge that we bring to goals for the patient, how do we balance the patient's desired outcome against our assessment of the patient's needs? I think the patient's desires are certainly of diagnostic value. I am also clear that a patient will pursue with more commitment outcomes that the patient agrees with. On the other hand, patients may have goals that in the eyes of the practitioner aren't possible, or aren't reasonable. We see that often enough with physical care. As I considered what it might mean in our work, I thought of the person who wanted reconciliation with a separated family member, but only on his or her own terms. I thought of the patient who wanted a closer relationship with God, to be measured by unalloyed happiness. Those goals are indeed where we start; but they are, as I said, of more value in assessing the patient's needs than as an outcome measure. Again, my point is not to reject these recommendations (even if they appear phrased as directions), but to consider how they might or might not be useful.
 
On the question of our tools: I have discussed this already when discussing assessment. As the structures within our tools will shape our assessment, so will they shape our documentation of care. In this case, we are like other practitioners in health care: we have processes that are easy to document, and outcomes that are harder. In our time of electronic documentation, this is no small issue. Processes are, if you will, binary: either they happened or they didn't. That makes them amenable to check boxes. Outcomes, on the other hand, are much more nuanced. We know reconciliation when we see it; but just to check a hypothetical box marked "Reconciled" won't tell us or anyone else anything. We can check a box marked "Renewed Hope," but we may well need to be specific about hope in what and for what.
 
Moreover, as much or more with our documentation of service as with our assessments, we need to pursue as best we can having our documentation read. That will, I think, take a two-pronged approach. The first is documenting, and documenting as clearly as we can. The second is knowing how other colleagues can and should see our documentation and taking opportunities to remind them it is there. In paper charts there have been divisions (physicians, nurses, social workers, lab work, etc.) and a risk that information would get "siloed" – separated in parallel but not intersecting categories, with boundaries crossed only by those interested when interested. Sometimes there was a clinical note process used by more than one profession, and that helped; but only when we used it diligently.
 
The same is true in electronic documentation. Some models might still separate information by practice. This can sometimes be aggravated by guidelines overzealous about HIPAA. An incomplete understanding of our participation on the health care team and some hyper-vigilance can end up cutting us off from relevant information, and cutting others off from us. So, it is important that we recognize the capacities and the limitations of our tools, our electronic medical records, and where necessary supplement them. That is, the best documentation is no substitute for engagement with colleagues on the units. We no that to be the case with paper documentation, and it does not change with electronic documentation. We will need to document effectively, and still periodically point others to our documentation. That, too, will be an ongoing educational process as nurses, social workers, and physicians come and go. 
 
So, as we live with the standard on Documentation, we can reflect and learn about what works for us, and how. We can also continue to pursue the professional relationships within which our documentation will have meaning. These are, really, issues we face with any new tools. Our opportunity in living out the Standards of Practice is to take on those issues with renewed energy and conviction of their value – and of ours.

Standards of Practice: Standard 3, Part A

This is a continuation of my reflections on the Standards of Practice for Professional Chaplains in Acute Care. If you are interested, you can access Standards and related information from this page. You can find my earlier posts on this subject by clicking on the link for Standards of Practice under the Label menu in the sidebar. 

The next section of “Section 1: Chaplaincy Care With Patients And Families” is “Standard 3: Documentation of Care.” The specific standard is “The chaplain enters information into the patient’s medical record that is relevant to the patient’s medical, psycho-social, and spiritual/religious goals of care.” This follows clearly from the Standards on Assessment and Delivery of Care. Information from the assessment directs provision of care; and having been provided, it is important that the care be documented. It is axiomatic in health care that “if it didn’t get documented, it didn’t get done” – that is, no one coming along later, whether another member of the team or a coder in Patient Accounts, will know what has been done for and with a patient, and what ought to be done next. If anything, this is more incumbent on spiritual care providers than on others. If a nurse gives a medication, there are very likely going to be measures affected – lab values, blood pressure, etc. As I have noted, our outcomes are rarely so readily connected directly to our work; and that makes it all the more important that our work be documented.

I have already considered that phrase, “relevant to the patient’s medical, psycho-social, and spiritual/religious goals of care” in a previous post, or at least about what is “relevant.” It should be noted, though, that central to this Standard, as understood by the Committee, is some further elaboration on “information… relevant to the patient’s medical, psycho-social, and spiritual/religious goals of care.” The Interpretation section includes this:

Documentation should include but is not limited to the following:

• Spiritual/religious preference and desire for or refusal of on-going chaplaincy care.

• Reason for encounter. • Critical elements of spiritual/religious assessment.

• Patient’s desired outcome with regard to care plan.

• Chaplain’s plan of care relevant to patient/family goals.

• Indication of referrals made by chaplain on behalf of patient/family.

• Relevant outcomes resulting from chaplain’s intervention.

This list of categories that we might call “necessary, if not necessarily sufficient,” provides its own framework of what is relevant. The question remains, though, as to whether these are the most appropriate categories.

Even accepting this list of “necessary if not sufficient” categories, there is another issue: what about our tools for documentation? Are they adequate to the task? Do we have adequate access? Are we using our tools as well as we can; and what might that mean? I will address that in a subsequent post.