Responses on not doing the right things right

What About Spiritual Care?
The Dialogue Continues

Editor’s Note: Because of the importance of the findings of Tracy Balboni's study to the profession of chaplaincy, we have chosen to post the replies to Rev. Handzo's response here and not in TalkBack. It is our hope that others will continue to respond to Mr. Jacobs and Rev. Handzo's questions and concerns.

I am amused—though not surprised—by the Balboni findings. I marvel that we speciously satisfy as many spiritual needs as we do. In order to deliver spiritual care, chaplains would probably have to intend it. Instead most healthcare chaplaincy continues to labor under older models of “religious care,” or even worse, “religious activities.” This is by no means entirely our fault.

Chaplains in faith based institutions often feel as if their care must follow party lines. They, as well as other healthcare professionals, color outside those lines at merciless and swift peril of their employment. Chaplains in secular institutions often feel marginalized as “religious artifacts,” nice to have, but not central to the real business of a hospital. Many smaller hospitals continue to assume that clergy volunteers will fill anyone’s—everyone’s—spiritual need. Chaplains in government institutions must often respond to the political pressure of sectarian interest groups with access to those in power.

Screening and assessment models for spiritual care abound. But when chaplains define the spiritual dimension in patient care by issue: hope, fear, awareness, meaning, dignity of life, identity, trust, the ability to give and receive, respect, self-responsibility, grief, even ethics: we are frequently told we are usurping ground from medicine, psychology, social work, or rehabilitation. “Aren’t chaplains supposed to pray and hold bible studies… how about those Sunday services?”

Any chaplain who also has experience in congregational ministry knows what it means to be told to “get back in the pulpit.” Chaplains will be able to substantively deliver spiritual care when the institutions that employ us learn the difference between a spiritual need and a religious one, and commit to delivery of the former.

The last decade has seen much fine writing on spiritual vs. religious care, not the least by published by JCAHO. Sadly, I have had to read those articles to administrators, prelates, politicians, and even a surveyor, to defend my own department’s modes of operation.

Advocacy begins at home. Department Heads: be clear with your institution. It is time to rewrite policies, manuals, scopes of service, job descriptions… the entire keyed infrastructure your institution requires from you. Be clear with your staff about their role. Can we really afford to be saddled with sectarian chaplains when they do not even meet the basic spiritual needs of their own supposed patient populations? And be clear with yourself. Can you admit that what you are doing is simply not working?

Balboni and Ferrell have done us a great favor by dropping at our feet a study that says: the religious constraints we have been asked to labor under simply do not meet the basic spiritual needs of patients. If we cannot use that to open a conversation with our selves, our staffs, and our institutions, then maybe it is time to get back in the pulpit.

The Rev. Dr. Howard W Whitaker, BCC
Director of Pastoral Service
Greystone Park Psychiatric Hospital
Morris Plains, NJ

It is extremely difficult to confront the skeletons in one’s closet, especially, perhaps, when the skeletons may very well raise the specter of professional inadequacy. So often I have heard from other chaplain colleagues something along the lines of “don’t rock the boat.” After all, this reasoning may go, most of our denominational endorsing agencies just want us to do our annual paper work and most of our administrators really don’t have a clue what we do, so why draw attention to how we do what we do? After all, the reasoning may continue, I am accountable to God!

I want to thank George Handzo for opening our collective closet and bringing one of our profession’s skeletons into the light. This skeleton is named QUALITY. Is what we do actually meeting the spiritual needs of none, some, most or all our patients? How do we know if we are meeting the spiritual needs of our patients? If we are unable to address the spiritual needs of all of our patients, what is in place to see they are addressed? When we ask the question of the “quality” of our work, it always brings up the fear that we may be missing the mark and that some outside standard is setting that mark. But standards and best practices are being developed and so is peer review. So let’s step up to the plate of quality and let’s find out if and how we may be missing the mark and do something about it. Once we identify some of the areas where we as a profession (or we as individual practitioners) may need additional work, then we can begin to address these shortcomings with more appropriate opportunities for professional development.

Respectfully,
Mark LaRocca-Pitts, PhD, BCC
Athens (GA) Regional Medical Center

Patients who report that their spiritual needs have not been met while they were hospitalized is truly hard to process. Press-Ganey scores related to the questions like , "Did you feel that your spiritual needs were met?" often are more about whether people felt cared about by staff at an emotional level. In our institution those scores showed up to be average until a patient care initiative was begun, and without the number of chaplain visits changing, that score improved remarkably.

As Pastoral Care providers, if we are to be judged for the provision of care, we should probably insure that patients who were asked those questions actually had a contact with a chaplain, requested a chaplain visit, or had contact with someone from the Pastoral Care Department. Some of that is dependent upon whether the patient intake process includes questions related to spiritual needs and whether the referral process is in place and working. As the size of institutions vary, so varies the chaplains per unit ratio, and the ability to provide intentional visits rather than visits based upon referrals.

Our hospital uses lay Pastoral Care Volunteers whose purpose is to stop by newly admitted patients to insure that they have been asked questions pertinent to their spiritual needs. The notion that someone may say their spiritual needs have been met or not met is then dependent upon their response to the volunteers. The fact that someone from the Pastoral Care Department has asked the question in and of itself, signifies that our department has an interest in the spiritual well-being of each patient, and that has more than once been met with surprise and appreciation, even if patients ask nothing further of the chaplains department

George Burn
Mount Nittany Medical Center
State College, PA

One has to look within and do a self examination of self and then ask themselves "How do I treat my fellow people that I meet minute by minute, day by day and then if they are treated to the best of my ability - I can honestly say I am doing the best job that I can and....... even with this assessment, there is always room for improvement. Ask anyone who you are working with, "do you think I am being honest with you?" If yes, you are doing your best, but I believe we delude ourselves sometimes and that is not always the case, and there is the problem. The answer to any problem lies within.

The Rev. Rose Marie Martino
St. Jude's Episcopal Church
Wantagh, NY
and
Winthrop University Hospital
Mineola, NY

To read the article to which this dialogue refers, please go to:
http://www.usatoday.com/news/health/2007-02-14-spiritual_x.htm?csp=34&POE=click-refer

Do you have thoughts about advocacy you’d like to share with your colleagues? Send an e-mail to info@PlainViews.org.