Karen Nelson, Director of Spiritual Care Services,

Chief of Social Work, Clinical Director Transitional Care,

The Ottawa Hospital

Vivian Stang, Chaplain, The Ottawa Hospital,

CASC Provisional Supervisor

Electronic partners in cultivating spiritual health: charting and surveys

Outline

Welcome and Introductions

Learning Goals

The Ottawa Hospital

Spiritual health and summary of literature

Documenting in the Electronic Health Record

Electronic survey of hospital employees

Chaplain’s focus group

Questions regarding research

Learning goals

• To better understand the benefits and challenges of electronic charting

• To consider the question of a standardized spiritual assessment template for our profession

The Ottawa Hospital

Spiritual Care Services team

Defining Spiritual Health

• “A connectedness with self, others, and the sacred that transcends and empowers the self.” (Como, 2007)

Summary of Literature Parish Nurses

- (Burkhardt, 2009) EHR provides an opportunity to collect and aggregate data related to the spiritual dimension of care and link spiritual care to health outcomes.

- Use standardized terminology and data collected by check-off lists/drop down boxes which are reliable, valid and measurable.

- To measure the impact of a spiritual care intervention, researchers can be consulted to design databases

- CEO’s have no info related to spiritual care or its impact on health outcomes beyond anecdotal evidence.

Summary of Literature U.S. Chaplains

• (Goldstein, 2011) 43/44 hospitals, chaplains have access to the EHR

• (McCarty, 2011) Use EHR to promote better care by highlighting our work

• How best to use the EHR to maximize our impact with the larger team?

• Content: balance substance with brevity • EHR communicates with the team why spiritual care is

important to the patient’s overall treatment plan• (Peery, 2008), EHR reflects value for our work as

chaplains• Helps us communicate more clearly with rest of the

team. As they better understand what we do they appreciate and utilize our services more effectively

Summary of Literature U.S. Chaplains

Handzo’s (2011) proposed electronic charting template:

• Spiritual Screening• Spiritual History• Spiritual Assessment• Profile/Diagnosis/Spiritual Treatment Plan• Interventions• Measurement/Current Assessment/Outcomes

Electronic Health Records in Canada

• Canada Health Infoway is an independent not-for-profit corporation created by Canada’s First Ministers in 2001, and funded by the Government of Canada.

• According to the Canada Health Infoway Corporate plan, 49% of Canadians now have electronic health records [in 2011] with the goal of ensuring 100% of Canadians have records in this format by 2016[i].

•[i] Canada Health Infoway. “2011-2012: Summary Corporate Plan”, https://www2.infoway-inforoute.ca/Documents/Infoway_Sum.Corp.Plan.2011-2012_EN.pdf. Retrieved April 19, 2011.

Electronic Health Records at TOH

• vOacis and experience from Social Work• Spiritual Care template based on different

assessment models • Jan. 2012 spiritual care assessments posted• In 2012-2013, 7 chaplains, 1 teaching

supervisor, & 11 intern chaplains completed 1018 spiritual care initial assessments & posted them on the patient’s EHR

• Typing and voice recognition software

Spiritual Care Initial Assessment

• Reason / Source for Referral:

• Personal / Spiritual History:

• Spiritual-Religious-Cultural Practices / Rituals:

• Spiritual / Emotional Status:

• Spiritual Support / Interventions:

• Outcomes:

• Spiritual Care Plan:

• (signature)

Spiritual Care Summary of InvolvementSource for referral:

Patient Nurse Social workerPatient’s family Physician Other:

Contact with:

Patient Patient’s family Other:

Personal/Spiritual/Religious History/Rituals:

Spiritual/Emotional Status:

Spiritual Support / Crisis Intervention:

Prayer Confession BaptismSacrament of the Sick Communion Confirmation

Other:

Outcome:Spiritual Care Plan:Follow up Other:Referral to:[signature]

Charting as Spiritual Practice by Jan Kraus Reasons for Referral & Spiritual History Referred by… Where/when you met pt Verbal consent obtained or consent by participation Describe what you observe, including mood/affect/speech patterns Pt said, ‘I feel so….When….’ Faith group affiliation, relationship with faith group and/or God Stress factors, especially within the past two years Support systems Spiritual/ Emotional Status

Your interpretation of the data. This may or may not have been directly stated in the visit

Describe how the pt experiences the divine. Other examples: Pt is experiencing…..complicated grief, multiple losses,

spiritual distress, spiritual growth and development, crisis of meaning & purpose, value clarification, crisis of faith, desire to reconnect with faith community, grace and forgiveness, hope, creativity, gratitude, search for meaning & understanding/

Spiritual Support/Intervention

Explored religious and spiritual practices Encouraged expression of feelings of…. Prayed/offered blessings Phoned ….at pt’s request or with pt’s permission Encouraged pt to continue….that have been helpful in the past Encouraged life review Educated pt re spiritual care services/Gave spiritual care brochure ( Giving the

pt/family a brochure or your business card along with verbal information) Outcomes

Pt expressed gratitude for ….staff/care/test results/family/decreased pain, etc. Pt actively engaged in conversation. Pt disclosed information about self and experience Pt requested….

Spiritual Care Plan

Will arrange for…sacramental ministry, communion, clergy follow up, anointing, assistance to attend religious services,

Will refer to… Will consult with…. Will inform…. Will follow up (when? daily, weekly, etc.)…for the purpose of ( addressing the

issue stated in your analysis)

Spiritual Support/Interventions: some suggestions to use with patient/family Use active verbs and descriptors

Addressed the issue of loss/grief/healthy or maladaptive coping….. Affirmed pt’s experience of …. Arranged for communion/clergy follow up/SOS/anointing Assessed pt spiritual need at the present time

Created a safe environment for the pt to express their concerns Communicated pt’s concerns to NP/MD/RD/RT/RN ect…

Educated about spiritual care services/ commonalities of human response to

loss/crisis/illness (normalizing_ Encouraged to verbalize experience of hospitalization and illness Engaged in active listening; in building a therapeutic relationship and/or alliance;

in cognitive re-structuring Explored pt’s belief system and how it impact their healing process

Facilitated contact with a local faith community/leader; family meeting; communication between the family members Informed about spiritual care services available to the pt/ how to contact a

chaplain Invited pt to express their feelings

Prayed with the pt/family (as per pt. request) for—give 2 examples: forgiveness,

healing, acceptance etc… Provided spiritual support and guidance/continuity of care./community/safe

environment Promoted the continuation of religious/spiritual practice while in the hospital

Read Sacred Scriptures as per pt. request

Supported pt’s expression of feeling/religious and spiritual beliefs and

practices/religious doubt Searched for meaning and purpose that the pt assigns to their life experience and

current suffering

Unable to complete assessment at this time due to (be specific)

To solicit feedback from our inter-professional colleagues about our new practice

www.fluidsurveys.com

Soliciting feedback via electronic survey

One electronic survey question

What was helpful about the spiritual care assessments on vOacis?

- Common location to be informed that a pt’s needs were being met

- Provided useful information about the patient’s spiritual values and emotional state

- More thorough and useful- Answered questions that I had, more in-depth

information of what the patient needs. Allowed me to formulate nursing interventions.

• Question 1: What do you like about our practice of posting our spiritual care assessment on vOacis?

- increased exposure and understanding of Spiritual Care- expands readership of assessments, more accessible- education about what we do is key - triggered more consults- provides access to previous notes when pt is readmitted- continuity of care has improved between chaplains- a quality improvement project

TOH Chaplain’s focus group

TOH Chaplain’s focus group- assessments are patient-centered and inter-

professional colleague centered- legible, faster, portable, thoughtful- more efficient and effective care- more customized care- standardized assessment increases predictability and

standardization of care- while on vOacis, I inform myself about the patient’s

medical background

TOH Chaplain’s focus group

Question 2: What benefits do you think electronic charting brings to your personal practice as a chaplain/priest, our SCS dept, and TOH?

• Helps to professionalize chaplains• Improved communication with staff ie: priest

has already come in to do SOS • All positive feedback from staff

Do we want to capture spiritual care data in a format that allows for data extraction and outcome research?

Do we want to capture data on the impact of spiritual care? By measuring spiritual distress at Time 1 and Time 2?

Do we want to partner with nurses or other hcp’s in research that links spiritual health to overall health outcomes?

Questions regarding research

Conclusions on electronic charting

• A work in progress• A way to communicate with the team that

spiritual care is important to the patient’s overall treatment plan

• As we educate others on the value of our work and the readership increases, our services will be used more effectively.

Bibliography

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• Burkhart Lisa. A click away: documenting spiritual care. Journal of Christian Nursing, 2005 Winter; 22 (1). • Burkhart Lisa. Integration: A documentation system reporting whole-person care, in Iowa Intervention

Project: Nursing Outcomes Classification, S. Moorhead, M. Johnson and M. Maas, ed. (St. Louise: Mosby, 2004) pp. 796-802.

• Cadge, Wendy, Paging God: Religion in the Halls of Medicine. Chicago: University of Chicago Press, 2012.• Como, June; Spiritual Practice; A literature review related to Spiritual health and health outcomes.; Holistic

Nursing Practice, vol. 21 (5) Sept/Oct. 2007, 224-236.• Goldstein HR. Marin D. Umpierre M. Chaplains and access to medical records. Journal of Health Care

Chaplaincy. 17(3-4):162-8, 2011. • Handzo, George, A standard System for Charting Spiritual Care in electronic Medical Records in Plainviews,

1/5/2011 Vol. 7, No.23.• Hatcher, Irene; Enhance pathways to make patient central focus. Hospital Case Management. 9(4):64, 50,

2001 Apr. • McCarty, Cassie, From Check-box chaplain to Dictation Diva: Tales from the EMR. In Plainviews, 2/2/2011

Vol. 8, No.1• Peery, Brent, Chaplaincy Charting: One Healthcare Systems Model. In Plainviews. 5/21/2008 vol. 5, No. 8• Peery, Brent, Memorial Herman Hospital, Texas medical centre Documentation model (Texas

Teleconference and date)• Spirit Chaplaincy software www.spiritforchaplains.com