Jane Mather, MA, BCCCHE 3-Part Series on

Documentation and AssessmentPart 2

Donovan helped us frame the need for and content of • Assessments • Plans of Care

Reminded us that we must be relevant• To the team • To patients’ care and healing

That we do have something to offer Encouraged us to be effective and use

understandable documentation language

The Equilibrium Model“The role of the clinically trained chaplain is to assess the degree to which the patient’s emotional and spiritual equilibrium has been disturbed by the healthcare event and to determine what interventions would be appropriate to help the patient restore their equilibrium and when such interventions should be employed.” (Donovan and Dowdy)

In terms of the patient’s plan of care

• Who needs their equilibrium assessed by a chaplain?

• If we do it, will it matter and why?

• What should we hope for?

Spiritual assessment is often clinician driven by • Medical Acuity • Medical emergency• Clinician need

Chaplains unable to assess proactively

Spiritual assessment not patient driven

All patients (whether in medical crisis or not) are seen as whole people inclusive of body, mind and spirit

Therefore…

Effort to heal includes assessing all dimensions of their being related to their illness or injury (in order to maximize equilibrium)

External• Time, money and staffing• Role misconceptions• Data-driven environment

Internal• Professional differences• Language barriers

What does that mean? Who do we ‘educate’? Why us?

What do we hope to see in a care plan as a result?

‘Educate’

‘Screening’and ‘Assessment’

‘Spiritual’ Care Plan (or plan that includes attention to spirituality)?

“To educate” – V.

“To draw out”…“To bring forth”

Getting the right experts to the point of need at the appropriate time

What experts do at the point of need to determine their

contribution to patient health!

Can any team possibly meet all psycho-social-spiritual needs?

Focus? What impacts health?

Q. How can we show the team what it looks like when “equilibrium” is disturbed and why it matters?

A. Educate/(draw from them)/model the meaning/teach the relevance – and measure the difference

Clinical staff with focus on “analysis”

And anyone who comes into contact with patients for any reason (to the extent possible)!

What matters/has meaning; beliefs/values impact choices and decisions (Spiritual needs)

That connectedness matters (Social needs)

These relate to what brought a patient into hospital (Physical needs)

Together they impact equilibrium

What does a “disturbed equilibrium” look like?

What dimensions might equilibrium have?• What matters to me as a person? My

values? My beliefs? • Who do I have around me to offer support?

What happens when those things are ignored or discounted?

“Always” “Sometimes” “Seldom” “Never”

Goal or target = “Always”… always

Integrated, holistic care plans that include • Psycho-social-spiritual screening and, if

indicated, • Assessment and re-assessment• Every patient, every time

Is it realistic with regard to psycho-social-spiritual care?

Screening by clinical staff Trained by chaplains Tracked in patient record for all to see

Engages team – especially clinicians

Makes whole-person care relevant

Exposes and integrates into care plan any patient issues that disturb equilibrium or . . .• Delay discharge• Hinder compliance• Are barriers to healing

They are dimensions of whole people and . . .

What might happen (is happening) when we fail to address them?• Quality of care is negatively impacted• LOS changes• Data defines patients• Bottom line suffers – along with patients

Might clinicians and daily caregivers ask some questions related to “equilibrium”?• How well are you coping?• To what extent are you in pain?*• To what extent are you at peace? (Steinhauser ) • How well/to what extent do you feel supported?

And could we calibrate the responses?

*Already asked!!

Would connect what patients need to what chaplains provide

to what the rest of the team sees…

And

Vice versa!!

Visible impact of our visits available to screeners

Tracks effectiveness of team awareness of/attention to overall wellbeing

Relates data to its meaning for patients’ healing process

We fail to connect our work to the overall care of patients?

•Essential pieces of whole person are missing from their chart…•and their experience

Chart focuses on silo-ed data

Care relegated to analysis w/o synthesis

We have unique skills that focus on meaning • Meaning impacts patient experience• Patient experience impacts patient

satisfaction• Patient satisfaction impacts reimbursement!

Reimbursement impacts quality of care …and jobs!

Team would be able to see Chaplain’s impact in chart?

Might eventually correlate other data to Chaplain interventions?

Chaplains need to leverage their expertise to teach!

"Our leadership legacy is not limited to what we accomplish; it includes what we leave behind in the hearts and minds of those with whom we had a chance to teach and work.”

Ken Blanchard & Phil Hodges, Lead Like Jesus