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.

CaseConference #12 Resolution

The chaplain made contact with the family and, aware of potential cultural issues associated with their background, suggested that she and the family talk in a private conference area. She explained the unit policies about communication and decision-making as belonging to the baby's mother, and asked mom if there was someone in the family she preferred to share decision-making with. When lively conversation ensued among the family members, the chaplain provided calm facilitation, which led to the decision that the maternal grandmother would be the co-decision maker and recipient of information.

The chaplain then explained the desire of the interdisciplinary team to honor and support religious beliefs and asked what the team needed to be aware of. Mom and the maternal grandmother explained their belief system, which was a combination of Pentecostal Christian and folk beliefs. The chaplain assisted in identifying the most important elements for the family and in explaining how they could be implemented and supported while staff's first priority needed to be the medical care of the baby. Parameters for family presence, interaction, and communication style were agreed upon, with the chaplain alerting the family that she would need to document the agreements for the staff in order to best meet the baby and family needs as well as the needs of all the patients and families in the NICU. Finally, the chaplain worked with the baby's nurse to arrange for all the family to come to the bedside for a brief chaplain-led prayer, emphasizing that this was a one-time-only event due to the baby's critical status.

The chaplain's interventions set the foundation for interaction with the family. The agreed upon parameters were documented, and staff was alerted to refer back to them in working with family members.The chaplain provided "on the spot" training to staff caring for the baby about the cultural background and belief system, including the cultural respect for religious leaders. When inevitable conflicts arose, the agreed upon parameters were followed and the chaplains were informed by the staff so that their presence would defuse the situation. Family requested that the chaplain provide daily prayer for the baby, who also maintained regular contact with the mom, grandmother, and other family.

CaseConference #12

A 16-year-old delivered a baby by caesarian section. The baby had cardiac anomalies which were discovered earlier in the pregnancy.

A large number of persons were present with her and the father of the baby at the hospital. The family identified themselves culturally as Gypsies.

After delivery, the baby was transported to the Nursery Intensive Care Unit. While numerous family members remained in the hallway outside the LD operating suite, several others went to the NICU demanding to see the baby.

Staff in both units attempted to explain the need for family to wait in the designated waiting areas, to lower their voices, and that medical information about the baby's condition could only be provided to the parents. Family members, including the patient's mother, became even more vocally upset in the units and connecting hallway. The nursing supervisor paged the chaplain to respond.

What is your role as chaplain in this situation?

Is crowd control part of your job?

Does the fact that the family "members" identify themselves as Gypsies affect how you deal with them?

What is your responsibility to the patient and his parents?

What is your responsibility to the staff who requested that you intervene?

Please check the archives below for comments made about the last CaseConference.

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