A Day in the Life: Observations of Chaplain Impact on Patient Experience

By Jane Robinson, HealthCare Chaplaincy Project Development Fellow

	Ms. Jane Robinson

As early morning light spills in through the window of a midtown Manhattan hospital room, eager fourth-year medical students crowd around the foot of a patient’s bed.  They are here for the day to observe the palliative care team in action as it makes rounds.  The patient in this case is a young, frail woman who we soon learn is suffering from terminal cancer.  While the head physician asks questions about her levels of comfort and pain, the woman pointedly looks to the group and pronounces, “So I am going to die, right?” 

An awkward stillness fills the room as everyone avoids the pleading in her eyes, and the doctor searches for an answer.  He turns to look past the students and asks for one person to stay behind with the patient- the professional, board certified chaplain.  As students hurriedly file out into the hallways, their thoughts skipping forward to the next medical condition in the next room, the chaplain takes a seat next to the patient.  The conversation begins simply with a “How are you?”, but quickly progresses as the patient begins to open up.  She speaks of the loneliness in the hospital, where her direct questions have gone unanswered and test results unshared. 

And she speaks of her fears: fear that her prolonged hospital stay may be cause for removal of her foster children from her home; fear of the cancer and her uncertain future; and fear of what her doctor said, “There is nothing more we can do for you, so you will be discharged.”

As tears are shed and anxieties expressed, the chaplain is there as a compassionate presence, to listen and to comfort.

Through two separate experiences shadowing professional chaplains at New York City hospitals, I was barely able to begin to scratch the surface in understanding just how much of an impact chaplains can have on patient experience.  Clark et al., in their piece Addressing Patients’ Emotional and Spiritual Needs, argue that patients can have emotionally and spiritually satisfying inpatient experiences if the following occur:

In both cases, I saw chaplains meet or exceed each of these criteria.

Many times, the chaplains I observed stepped in to advocate for wishes of patient and family.  An elderly cancer patient who had recently traveled to the U.S. to visit her daughters was hospitalized with a very poor prognosis.  She insisted that she return home to die.  The chaplain helped coordinate discharge and travel plans, communicating with the medical team and providing reassurance to the daughters.  The chaplain was also able to comfort the patient, who was non-English-speaking and Catholic, as well as her family, by arranging for a priest to come prior to departure and bless the trip. This is just one example that demonstrates how the professional chaplain provides expert consultation on patient and family cultural and religious practices and beliefs.

The chaplains I observed worked to communicate patients’ treatment desires to the care team, as well as make the case for shared decision-making. At one hospital I observed the palliative care team engaged in interdisciplinary discussion. The chaplain, nutritionist, social worker, pain management specialist, doctor, and nurses met regularly in the Intensive Care Unit to discuss patient cases.  In this forum, the chaplain was able to speak to the spiritual needs of the patient and comment on possible distress, difficult family dynamics, or expressed care preferences.  The team then worked together to create the best plan of treatment possible for each patient.

Finally, the chaplains I observed served as empathetic and emotionally supportive resources for patients, shaping quality of care through the provision of comfort.  They were able to move beyond the immediate medical situation to provide broader support for an emotionally distraught patient.  I witnessed the comfort a chaplain provided to a soon-to-be discharged patient who had just learned of a close friend’s death.  The chaplain helped him to open up and discuss the loss, offering a soothing prayer at the close of the visit. 

Research has shown that a hospital staff’s ability to address the emotional and spiritual needs of its patients is reflected in patient perception of overall experience.  Not only is patient perception important for positive outcomes; patients’ assessments of their experience are now affecting how hospitals are being compensated for the services they deliver.  As a result, professional chaplains have an increasingly crucial role to play on the hospital team.

Faculty Member Receives Major Honor from the Racial Ethnic Multicultural Network

By Sandra Lee Jamison, HealthCare Chaplaincy Research Librarian

The Rev. Jonny Bush

At its recent annual conference, the Racial Ethnic Multicultural Network (REM) of the Association for Clinical Pastoral Education elected the Rev. Johnny Bush as its chair.

For HealthCare Chaplaincy the Rev. Bush teaches and supervises the chaplaincy interns of our clinical pastoral education programs at New York Hospital Queens and Vassar Brothers Hospital in Poughkeepsie.

For 25 years the REM Network has played an important role in growing the diversity of educational supervisors. The Rev. Bush, the only African American male ACPE supervisor certified in the Eastern United States region within the last 20 years, considers himself a product of REM's historic work, He says, that it was the network that helped him recognize his call to become an educational supervisor.
 
“I’ve benefitted from standing on the shoulders of REM’s founders and elders,” says the Rev. Bush.  "My commitment to REM is out of deep appreciation for what they did for me. Their heartfelt mentorship prepared me to be elected chair of the network.”

As an alumnus of HealthCare Chaplaincy’s supervisory education program, the Rev. Bush says he is grateful to HCC for recognizing his potential and its support in his training to become a supervisor.  

Over 11 years as a supervisor he has helped hundreds of chaplaincy interns bring meaning and comfort to thousands of people in hospitals, long-term care facilities and elsewhere.

In addition to his work as a member of the HealthCare Chaplaincy faculty and for the REM Network, the Rev. Bush is a congregant pastor with Greater Faith Baptist Church in Stamford, Connecticut.

Much HealthCare Chaplaincy News in Spring Beacon

The printed edition of The Beacon bulletin for spring has been mailed to print subscribers, and now you can read it online: http://bit.ly/GRWYVi

Contents include:

Now’s the Time to Act:
National Healthcare Decisions Day is April 16

Health Care Proxy. Medical Power of Attorney. Living Will. Do Not Resuscitate Order. Organ and Tissue Donation.

It’s likely you’ve seen one or more of these terms.

All refer to documents that stipulate your medical treatment choices and are collectively referred to as “Health Care Advance Directives.”

We know many people who ask, “What do they mean exactly? Where can I learn more?”

Now’s the time to answer those questions, because April 16th is National Health Care Decisions Day, a collaborative effort of national, state and community organizations committed to ensuring that all American adults with decision-making capacity have the information and opportunity to communicate and document their health care decisions.

To help, HealthCare Chaplaincy has created this brief primer.

Who will be your health care agent?

The first step in planning ahead is to choose the person who will make your medical decisions for you, should you lose the ability to communicate them for yourself. It’s important to let your agent know your choices beforehand. It’s also a good idea to speak with your family and close friends so your agent has their support.

What types of documents do you need?

This is where the Health Care Advance Directives come in. They exist in two formats and are documents that let you do a number of things. With a Health Care Proxy you can appoint your health care agent who will make medical decisions for you. With a Living Will you can spell out your wishes in the event of a life-limiting condition. You can request the use of all available treatments, the stopping of treatments, or anything in between.

Where do I start?

Start with the health department website of the state where you live, because different states have different forms. If you’re a New Yorker, the Family Health Care Decisions Act allows certain family members to make medical decisions on your behalf in hospitals or nursing homes. However you should fill out Medical Advance Directives because a Health Care Proxy will allow you to plan for non-hospital and non-nursing home medical decision-making. Most importantly it will let you choose who should advocate on your behalf and make end-of-life decisions for you based on discussions you’ve had with them. See http://www.health.ny.gov/publications/1503.pdf

Other sources for forms and Frequently Asked Questions include: National Health Care Decisions Day (http://www.nhdd.org); Caring Connections (http://www.caringinfo.org);
and the Commission on Law and Aging (http://www.americanbar.org/groups/law_aging.html).
A helpful video is available at the American Health Lawyers Association: http://www.healthlawyers.org/hlresources/PI/InfoSeries/Pages/LovingConversations.aspx

There are also Health Care Advance Directives for specific religions.

What else to know

Give a copy of your Health Care Advance Directives to your Health Care Agent, your doctors, and any hospital you visit regularly.

If you change your documents, updated copies should be distributed to the same persons. You can register with companies like the U.S. Living Will Registry® (http://uslivingwillregistry.com), Docubank (www.docubank.com) and Google Health (www.google.com/health), that will store and provide copies of your HealthCare Advance Directives should they become necessary.

Learn now. Act now.

Let National Health Care Decisions Day be a wake-up call to communicate and document your health care decisions.

We thank Nathan Kottkamp, chair of National Healthcare Decisions Day, and Tina Janssen-Spinosa, Esq. of the New York Legal Assistance Group (http://www.nylag.org/) for their help in creating this alert.

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