We post an ethical or situational concern that has arisen in a facility where one of our readers works. It has no identifiers included. It gives you only the facts of the case. Then, you can respond to that concern. This is an ongoing dialogue, with comments added as they come in. In the following issue, assuming it has been resolved, we give you the outcome from the facility where the incident took place. Please send any cases that you would like considered for inclusion to: info@plainviews.org

We hope that this new addition will help to inform not only those who are dealing with the issue, but will enable all of our readers to learn from the experiences and perhaps mistakes of others.

PLEASE NOTE: Due to unanticipated continuing responses to both the case and the resolution of the case, added responses can be viewed in the archives. Click HERE.

Case Conference #2 Resolution

The chaplain returned to the patient’s treatment area. She thanked her for the gift and told her how much the gesture meant to her, but that she wouldn’t be able to accept the earrings. Chaplain and patient talked about their relationship and the patient’s anxieties about entering a new phase of treatment. The chaplain assured she would continue to be available to the patient.

The following work day the chaplain spoke with the patient’s regular nurse, who asked if they could speak in private. The nurse told the chaplain the patient had tried to give her some earrings (the nurse wasn’t aware of the interaction between patient and chaplain). She hadn’t accepted them. The nurse then expressed concern about the patient’s financial and emotional state.

The chaplain inquired about whether there had been an interdisciplinary team conference for this patient. According to the nurse, none had taken place. The chaplain initiated one, and it occurred the following week.

What emerged during this conversation was a more complete picture of the challenges facing this patient and the emotional/mental, financial, and physical challenges team members had tried to address. It became clear that the care team had been ‘split’. As the meeting progressed, trust was built between providers and a consistent care plan emerged. The chaplain has a deeper appreciation for honoring administrative policy and functioning as an interdisciplinary team, ideally before crisis occurs.

CaseConference #2

A chaplain was referred to a patient by a surgeon. The patient had just delivered her third child when she was diagnosed with breast cancer. Surgery and chemotherapy followed. Over the next three years the chaplain visited with the patient and her family whenever the patient was at the Outpatient Clinic, offering prayer support, referrals to support services, etc.

One day the chaplain visited the patient. The patient reminded her this was her last chemotherapy session and she wanted to give the chaplain a gift of a pair of earrings “in appreciation for all you’ve done for me. I genuinely love you and am so grateful you’ve been there.”The chaplain indicated that she was touched by the gesture, but wouldn’t be able to accept them. The chaplain was aware of an institutional policy against the giving of gifts to staff by patients.

The patient began to cry and became very emotional, stating, “I didn’t mean anything bad by it. I don’t want to get you in trouble. You’ve just meant so much to me and my family and I wanted to show you how much I appreciate it.”

The chaplain then received the earrings, and thanked the patient. She then contacted her supervisor, who made inquiries with the administration regarding the specifics of the policy and whether there were any exception clauses. The chaplain wanted to honor the institution’s policies, but also wondered if refusing the gift would create harm in the patient. Administration answered that there were not acceptable exceptions to the policy, and the chaplain would need to return the earrings.

Could the chaplain have handled this differently so that the patient would not have been as upset? Is there ever a time that a gift can or should be accepted? Should patients be informed in some way that the hospital has a policy of "no gifts to staff" so that this would not even become an issue?

Please check below for comments made about the last CaseConference.

Send your comments about CaseConference to info@PlainViews.org.