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While a professional chaplain is the spiritual care specialist on the interdisciplinary health care team, there is growing recognition that delivery of spiritual care requires the participation of nurses, social workers and other team members as spiritual care generalists. Nurses and social workers receive little or no professional education training in spiritual care yet they say they very much want it.

Therefore, HealthCare Chaplaincy Network (HCCN) and the Spiritual Care Association (SCA) have created these two opportunities to raise nurses' and social workers' spiritual care knowledge and delivery:
The first opportunity is four online courses through the Spiritual Care Association's Foley Learning Center:
Each course was written by a subject-matter expert, uses a state-of-the-art learning management system, is self-directed and can be taken at your own pace, and upon completion earns one a certificate of completion and continuing education hours.
Learn more about the spiritual care generalist courses for nurses, for social workers and the Foley Learning Center on our website. The fee for each course is $295 for SCA members and $495 for non-members. 
Learn about all the benefits of SCA's annual membership for health care professionals.
Earning the first-of-its kind Certificate as a Spiritual Care Generalist is the other learning opportunity for nurses and social workers who attend this preeminent, multidisciplinary professional education opportunity in spiritual care and meet the requirements:
Find details about the conference and this unique Certificate program here

For those of you who are not a nurse or social worker, I ask that you forward this to those whom you know to inform them of these learning opportunities that so many of them say they desire.

Please send any comments or questions to comm@healthcarechaplaincy.org.
Rev. Eric J. Hall
President & CEO
HealthCare Chaplaincy Network and
Spiritual Care Association
There is growing recognition that excellent patient experience encompasses the whole person, including spiritual care. For that reason HealthCare Chaplaincy Network has published the attached white paper ─ "SPIRITUAL CARE: What It Means, Why It Matters in Health Care" ─ a milestone publication for the field. No other document has presented with such clarity and with such comprehensive source documentation (93 footnotes) on these topics:
  • What is Spiritual Care
  • Spiritual Well-Being
  • Spiritual Care and Patient Satisfaction
  • Spiritual Care Generalists and Specialists
  • Role of Board Certified Chaplains
  • Bottom-Line Impact of Spiritual Care
In addition, this white paper describes how professional chaplaincy is evolving to become an evidence-based profession with objective standards for quality care and scope of practice similar to other health care disciplines. There is substantial support in the field for this forward movement.
I hope that you find this white paper useful, and I encourage you to share this with others who would find it informative ─ chaplains, administrators, nurses, social workers, physicians, educators, students, volunteers, policy makers and others who are interested in whole person care.  The white paper is also online at www.healthcarechaplaincy.org/spiritualcare.
I welcome your comments at eric.hall@healthcarechaplaincy.org.
Peace & Blessings!
Rev. Eric J. Hall
President & CEO
HealthCare Chaplaincy Network & Spiritual Care Association
   October 2016   Issue No. 14
Patient-Centered Care News
Every month we select ten articles from the many published recently. This month we present twice that, because there is so much good writing that reflects the growing commitment to patient-centered care. In addition, at the end of this message you will find announcements about valuable spiritual care resources, including free webinars this week and next and early bird registration for the "go-to" interdisciplinary event for spiritual care next March in Chicago ─ the fourth annual Caring for the Human Spirit® conference.
We hope that you find this complimentary monthly e-newsletter informative. Below are short summaries of each selected item with links to the entire pieces. Also included is a downloadable PDF version for readers who prefer that format.
Please feel free to send any questions or comments to comm@healthcarechaplaincy.org.
Rev. Eric J. Hall
President & CEO
HealthCare Chaplaincy Network & Spiritual Care Association
Thought for Today ----    An Imperative for the Chaplaincy Profession
"Chaplains (must) address questions regarding the basic concepts of outcome and evidence: Why are these concepts so important to healthcare? How can we demonstrate the value of the professional chaplain in a language that both physicians and administrators can understand and appreciate? Can the chaplain truly measure the care provided in such a way that it maintains the integrity of the care while measuring its impact on health and the bottom line?"

Source: Harold G. Koenig, M.D. & Kevin Adams, M.Div., BCC, "Religion and Health," Association of Professional Chaplains publication, Healing Spirit (Fall 2008)
Spirituality & Health Care

Spiritual Care "Is Silent Revolution That's Transformed Healthcare" (Religion & Ethics Newsweekly)
More and more hospitals are now putting added emphasis on the spiritual care of their patients, and it is paying off both figuratively and literally. Correspondent David Tereshchuk reports from Mount Sinai Hospital in New York City, where he interviews hospital chaplain Father Rick Bauer, who says that more than any other health professionals the chaplain "has the ability and the job to be totally present to you and listening to you." He also talks with Dr. Christina Puchalski, founder and director of George Washington University Medical School's Institute for Spirituality and Health about the improved outcomes that result from having chaplains available to patients and the benefits for medical institutions of having better patient satisfaction. Says Dr. Puchalski: "You can't practice excellent patient care if you don't practice excellent spiritual care."
Exploring Nurse Communication About Spirituality (American Journal of Hospice & Palliative Medicine)
Conclusion: It is evident that patients want to discuss spiritual topics during care. Study findings illustrate the need to develop a spiritual communication curriculum and provide spiritual care communication training to clinicians. 
California Is The First State To Require Spiritual Care In Health Care (Huffington Post)
If you get sick in California, and you are covered by the state's Medi-Cal health insurance, you will be pleased to know that your health care just got better. California is the first state to recognize that spiritual care is a standalone discipline in health care and a trained and certified palliative care chaplain must be available for any patient who wants one. Spirituality, defined in the Clinical Practice Guidelines for Quality Palliative Care is a "fundamental aspect of compassionate, patient-and family-centered care that honors the dignity of all persons."

The California Department of Health Care Services policy now calls for a palliative care team to meet the physical, medical, psychosocial, emotional and spiritual needs of you and your family; and recommends that the team include, but is not limited to a doctor of medicine or osteopathy, a registered nurse and/or nurse practitioner, a social worker, as well as a chaplain....

Hopefully this serves as a model that all states will soon follow for the good of patients and their families. 

Patient Experience

3 Ways to Improve Patient Experience With Empathy (The Beryl Institute)
Here are three strategies any healthcare organization can adopt to make a measurable difference in the quality of the patient experience.

* Affirm Emotions
* Hear the Story
* Be Creative

Read more
Health Care Administrators Who Claim "I Don't Do Direct Patient Care" (The Beryl Institute)
There appears to be a divide in healthcare into clinical and administrative silos. Two different approaches to healthcare, but both are supposed to have one clear objective: make patients and their families the number one priority. There has to be a way to tie the two functions together to see not only how each group not only takes part in creating the patient experience, but also how both roles need to be symbiotic in creating value for the patient. 
A Patient and Social Worker Writes: "Stop With the Unnecessary Questions" (KevinMD)
When I find a lump in my left breast, I am stunned. I probably shouldn't be surprised, but I'm immobilized. It takes me several days before I tell my partner, who has to push me into action. I get the referral from my doctor and schedule a mammogram. The radiology practice fits me into their schedule that same week, but I still have several days to sit with the unknown.

Finally, the day of the appointment comes. I wait in the reception area for an hour before the x-ray technician calls my name. As we walk to the exam room, me in my usual long leg braces and aluminum forearm crutches, she is chatty and asks, "How did you get here today?" 
Fragmentation of Care: Necessity? Opportunity for Quality? (PlainViews® from HealthCare Chaplaincy Network)
Recently, I responded to an email from a professional chaplain who told us the story of his own hospitalization that was characterized by multiple caregivers who didn't communicate well, unneeded treatments, lack of communication with him as the patient about side effects and no contact with chaplaincy. Not an unfamiliar story unfortunately.

A couple of people who saw my response encouraged me to disseminate it further. Here is my somewhat edited response. 
Articles by Physicians

Five Tips for Effective Quality Improvement in Palliative Care and #3 Will Blow You Away (Pallimed blog)
  • Tip #1: Define the problem - Have a problem statement.
  • Tip #2: Define the problem, again.
  • Tip #3: Problem first, solutions (much) later.
  • Tip #4: Have an aim statement.
  • Tip #5: Explore the "Why".
The "Surprise Question" May Help Stimulate Palliative Care Discussions
(AAHPM SmartBrief and MedicalResearch.com)
The "surprise question" -- "Would you be surprised if this patient died in the next year?" -- helped identify primary care patients at risk of death but missed most patients who could benefit from palliative care, said researcher Dr. Joshua Lakin at Harvard Medical School. The study in JAMA Internal Medicine tested the screening method in a diverse, primary care population. 
The Special Nature of Palliative Care - for Both Patients and Caregivers (genesishealth.com)
Palliative Care offers family meetings and helps to ease the discussion between the patient and family members about overall goals and what types of care are best for an individual. We all have a different view of quality of life. What is important to one patient may not be important to another.

Our goal is to listen to patients and develop an understanding of what quality of life means to them, and then convey this to family members and other members of the medical team.  
Patients Want to Make Their Own Informed Choices. We Need to Let Them. (KevinMD)
Patient-centered care is often talked about as a virtue worthwhile to attain because it puts them at the heart of their health care team.  Empowerment goes one step further by actually giving power and authority to the patient.  It is a very important concept that is often missed in the world of big-box medicine today.  There is actually an organization devoted to this concept called the European Network on Patient Empowerment (ENOPE).  According to them, an empowered, activated patient:
  • understands their health condition and its effect on their body
  • feels able to participate in decision-making with their health care professionals
  • feels able to make informed choices about treatment
  • understands the need to make necessary changes to their lifestyle for managing their condition
  • is able to challenge and ask questions of the health care professionals providing their care
  • takes responsibility for their health and actively seeks care only when necessary
  • actively seeks out, evaluates and makes use of information
The Lost Art of Asking Questions (Kevin MD)
Most people know from experience or through intuition that there is a right time and a right way to ask important or sensitive questions. You don't usually just blurt out requests for raises or marriage proposals, for example.

In many areas of life, knowing when and how to ask difficult questions is viewed as an extremely valuable skill, for example in criminal investigations and in journalism.

In some cases, this kind of skill can even make you a media star: Interviewers like Barbara Sawyer, Oprah Winfrey, and Howard Stern are more famous and better paid than most of the celebrities they engage in intimate conversations in front of their national or worldwide audiences.

This year, the U.S. presidential debates have been said to require unusual savvy from their moderators and their performance may even affect the outcome of the election.

Why is it, then, that in health care, so little value is placed on when and how you ask sensitive or important questions?
Palliative Care

Most Hospital Palliative Care Programs Are Understaffed (eHospice USA and Kaiser Health News)

In 2013, two-thirds of hospitals with at least 50 beds reported having a palliative care program. At hospitals with 300 beds or more, the figure was 90 percent, according to a study published in the Journal of Palliative Medicine earlier this year.

But not all programs provide the same level of service. In the September issue of Health Affairs, an analysis of 410 palliative care programs found that only 25 percent funded teams in 2013 that included a physician, an advanced practice or registered nurse, a social worker and a chaplain, the four positions that are recommended by the Joint Commission, which sets hospital standards, including those for accreditation. If "unfunded" staffers were counted, those who were on loan from other units, for example, the figure rose to 39 percent. 
'Mystery Shopper' Study Finds Barriers To Palliative Care At Major Cancer Centers (Science 2.0 and American Society for Clinical Oncology)
A team of researchers, using a novel approach, found that while many cancer centers offer palliative and supportive care services, patients may face challenges when trying to access them. The study showed that expanding awareness and education to patient-facing cancer center employees about such services could make an important difference. This study will be presented at the upcoming 2016 Palliative Care in Oncology Symposium in San Francisco.

Read More

Related to the "Mystery Shopper" story: What  Is Your Front Desk Saying About Palliative Care? (Geripal)
End-of-Life Care

What It Feels Like to Die (The Atlantic)
Science is just beginning to understand the experience of life's end. ... During six-and-a-half years of treatment, although my mother saw two general practitioners, six oncologists, a cardiologist, several radiation technicians, nurses at two chemotherapy facilities, and surgeons at three different clinics-not once, to my knowledge, had anyone talked to her about what would happen as she died.

There's good reason. "Roughly from the last two weeks until the last breath, somewhere in that interval, people become too sick, or too drowsy, or too unconscious, to tell us what they're experiencing," says Margaret Campbell, a professor of nursing at Wayne State University who has worked in palliative care for decades. The way death is talked about tends to be based on what family, friends, and medical professionals see, rather than accounts of what dying actually feels like.

James Hallenbeck, a palliative-care specialist at Stanford University, often compares dying to black holes. "We can see the effect of black holes, but it is extremely difficult, if not impossible, to look inside them. They exert an increasingly strong gravitational pull the closer one gets to them. As one passes the 'event horizon,' apparently the laws of physics begin to change."

What does dying feel like? Despite a growing body of research about death, the actual, physical experience of dying-the last few days or moments-remains shrouded in mystery. Medicine is just beginning to peek beyond the horizon. 
At the End of Life, Searching for the Right Word (KevinMD)
Writes the daughter about her mother in hospice care:
I clicked on an article titled, "What Happens to My Body Right After I Die." In the third paragraph I read, "At the moment of death, all the muscles in the body relax ..."

I read the line again. "At the moment of death, all the muscles in the body relax."

My eyes lingered on the word "relax." As I stared at it, I took a deep breath and felt the knot in my stomach ease.

Maybe "fighting" is the word that an endless line of others needed or will need as they watch their loved ones slowly exit life, but it wasn't the word I needed.

I needed the word "relax." That word felt comforting, compassionate, acceptable.

On day eight, I didn't ask the nurses, "How much longer?" I didn't need meaningless words to fill the space between the question and the inevitable, unknowable answer.

Instead, I whispered in Mom's ear, "I love you." And then, I sat patiently by her bed and waited for her to relax.

And finally, on day nine, as I held her hand, she did.
Calming Effect: Families Turn to Hospice Workers to Help Ease Final Goodbye (Chicago Tribune)
Hospice nurses, who are sometimes referred to as palliative care nurses, are registered nurses who care for patients who are no longer responding to medical care. "On its surface it sounds morbid, but it's really a peaceful process," says Barbara Metzger, a University of Illinois Chicago graduate who has been practicing hospice care for 12 years. "You're working with the patient to make sure he or she is comfortable and safe, and you're preparing the family for the inevitable." 
Caregivers Are Suffering

Family Caregivers of Patients With Advanced Cancer Report High Anxiety, Depression (Oncology Nurse Advisor)

Nearly 25% to 33% of family caregivers of patients with advanced cancers report high levels of anxiety and depression symptoms, as well as significant time providing care, a study that will be presented at the 2016 Palliative Care in Oncology Symposium in San Francisco, California, has shown. 
Unusual News

Geisinger Refunds Patients $400,000 for 'Uncompassionate Care' (Becker's Hospital CFO)
As of August, Geisinger Health System in Danville, Pa., returned more than $400,000 to dissatisfied patients since the health system launched its ProvenExperience initiative in November 2015, reports The Daily Item.
Under the ProvenExperience initiative - spearheaded by President and CEO David Feinberg, MD, and piloted last October - patients can request refunds if they are dissatisfied with their hospital experience. Refunds work on a sliding scale, meaning patients can seek refunds as little as $1 to more than $2,000. 
Free: Two Webinars This Week and Next
Wednesday, October 19th: Free Live Q&A Forums About the New Spiritual Care Association hosted by prominent health care chaplains the Rev. Sue Wintz, BCC and the Rev. George Handzo, BCC
October 25th: FREE "Advocacy for Spiritual Care in a Changing Political Environment" presented by Washington, DC expert M. Todd Tuten ─ Senior Policy Advisor, Akin Gump Strauss Hauer & Feld LLP 
"Reforming Chaplaincy Training" Webinar
October 27th: Presented by the Rev. David Fleenor, BCC, ACPE Supervisor, Director of Clinical Pastoral Education, Mount Sinai Health System
Early Bird Registration Now Open for the "Go-To" Interdisciplinary Conference on Spiritual Care
Subscribe to the Preeminent Monthly Professional Journal for
Effective Chaplaincy Practice
Learn More & To Subscribe Here
HealthCare Chaplaincy Network™ (HCCN), founded in 1961, is a global health care nonprofit organization that offers spiritual care-related information and resources, and professional chaplaincy services in hospitals, other health care settings, and online. Its mission is to advance the integration of spiritual care in health care through clinical practice, research and education in order to improve patient experience and satisfaction and to help people faced with illness and grief find comfort and meaning--whoever they are, whatever they believe, wherever they are. For more information, visit www.healthcarechaplaincy.org,  call 212-644-1111, follow us on Twitter or connect with us on Facebook
The Spiritual Care Association (SCA) is the first multidisciplinary, international professional membership association for spiritual care providers that establishes evidence-based quality indicators, scope of practice, and a knowledge base for spiritual care in health care. As health care providers emphasize the delivery of positive patient experience,  SCA is leading the way to educate, certify, credential and advocate so that more people in need, regardless of religion, beliefs or cultural identification, receive effective spiritual care in all types of institutional and community settings in the U.S. and internationally.  SCA is committed to serving its multidisciplinary membership and growing the chaplaincy profession. For more information, visit www.SpiritualCareAssociation.org, call 212-644-1111, follow on Twitter or connect on Facebook and LinkedIn. The nonprofit SCA is an affiliate of HealthCare Chaplaincy Network™ with offices in New York and Los Angeles.
FREE ─ "Advocacy for Spiritual Care in a Changing Political Environment" ─ October 25, 2016 Webinar (1:30-3 PM ET)
Hear M. Todd Tuten, senior policy advisor, Akin Gump Strauss Hauer & Feld LLP, Washington, DC, and an expert on health care policy, legislation and regulation, discuss:
  • The important role of spiritual care advocates in shaping public policies related to health care
  • The outlook for legislative and regulatory action and the potential agendas of the new Administration and the next Congress
The Spiritual Care Association is pleased to make this webinar available at no charge as a benefit for all who provide spiritual care and for all who seek to make spiritual care a priority.
If you have any questions, please contact events@healthcarechaplaincy.org
HealthCare Chaplaincy Network™, a global leader in professional spiritual care, now offers this package of resources to enhance, improve and expand the level of spiritual care in your organization.  These high-quality, robust resources were created to support your chaplaincy staff and spiritual care initiatives.
The special offer includes:
  • Telechaplaincy Services
  • Excellence in Spiritual Care Award
  • Educational Videos
  • Spiritual Care Grand Rounds Webinars
  • The Chaplain Connection®
  • PlainViews®
  • Volunteer Training Manual
  • Meditative Spiritual Techniques
  • Handbook of Patient's Spiritual and Cultural Values for Health Care Professionals
  • An Invitation to Chaplaincy Research Handbook
  • Caring for the Human Spirit® Magazine
  • Prayer Cards
The $5,000 rate is for one-year and renewable annually.

For details please download the information sheets.  

You can also learn more by contacting: 

The Rev. Amy Strano
Director, Programs and Services
HealthCare Chaplaincy Network™
T 212-644-1111 x219

To celebrate the Spiritual Care Association's rapid growth in six months to more than 1,000 members and offices in nine countries, we are pleased to announce these two special offers:

1. Half-price membership in the Spiritual Care Association for the three membership categories for the first year of membership. This limited-time offer is available through October 31 and exclusively for people who are not already members. Join the more than 1,000 people who have already taken advantage of the considerable benefits of membership. To view the annual benefits, the normal annual membership fee, and to join, click here and insert discount code OCTOBER during payment for the membership category for which you qualify.

2. Half-price application fee for Path 1 or 2 Board certification in the Spiritual Care Association. This limited-time offer requires that you submit your application no later than October 31 and requires becoming a SCA member. This offer is available both for SCA new members and current members. Download the application form in the Certification section of the SCA website. Applications must be postmarked no later than October 31.

For certification requirements, click here. Members can access the application by logging in and clicking "Apply Now" on the Board Certification page of the SCA website.

If you have any questions or comments, please contact us at info@spiritualcareassociation.org.
Thought for Today ----    An Imperative for the Chaplaincy Profession
Concerns raised by thought leaders for decades about gaps in the field of spiritual care are taking on increased urgency. Without evidence-based tools as a framework for care ----    specifically, measurable quality indicators and set of competencies, the field is hard pressed to validate the contribution spiritual care makes to quality health care. Without consistent training and certification based on demonstration of clinical competencies, it is difficult to identify chaplains who can provide the most effective care.
New Fall/Winter Catalogue of Spiritual Care Educational Offerings
In line with the above thought, HealthCare Chaplaincy Network (HCCN) and the Spiritual Care Association (SCA), HCCN's affiliate multidisciplinary professional membership organization, offer high quality educational offerings to enhance professional practice and to advance the field of spiritual care. You may be aware of some of these resources but perhaps not the full array:
The Spiritual Care Association Learning Center's Seven Benefits:
  1. Features 16 online courses created by experts
  2. The most comprehensive, evidence-based curriculum in the spiritual care field
  3. Each course created to lead to quality outcomes because each is based on standardized, evidence-based quality indicators and scope of practice developed by expert panels 
  4. Convenient ─ Easily accessible plus learn online at your own pace
  5. Cost-effective: Individual online course price for Spiritual Care Association members is $295 and $495 for non-members.
  6. Earn certificate and continuing education hours upon completion
  7. Is for spiritual care specialists and generalists: Chaplains, NursesSocial Workers, Physicians, Administrators, other health care professionals, Religious/Spiritual/Existential Leaders, Clergy, and Seminarians
16 Courses Now Online + More to Come
  1. Building and Maintaining a Chaplaincy Department
  2. What to Do with Information: HIPAA and Confidentiality
  3. Talking about What Matters: Advance Directives and Planning
  4. What We Do Matters: Continuous Quality Improvement within Chaplaincy and Health Care
  5. What We Hear and Say: Spiritual Assessment and Documentation
  6. More than Listening: Counseling Skills
  7. When Care is Tough: Supporting the Interdisciplinary Team
  8. Values, Obligations and Rights: Health Care Ethics
  9. Powerful Communication Techniques
  10. Living with Heartbreak: Grief, Loss, and Bereavement
  11. Far Too Soon: The Anguish of Perinatal Loss
  12. Cultural Competence, Inclusion, and Vulnerable Populations
  13. Caring for the Smallest: Pediatrics
  14. The Challenge of Memory: Alzheimer's and Other Dementias
  15. Delivery and Continuity of Care for Chaplaincy Care
  16. When It's Time to Say Goodbye: Introduction to Spiritual Care at the End of Life
Typical Praise for Online Learning Center
A pediatrics chaplain at a major academic medical center who completed the pediatric course has said:
"I love all the resources (especially the charts that made some of the child development stuff more accessible in a quick fashion), and I passed along a few articles to our bereavement coordinator. I also appreciate the quick response to my questions and concerns."
   September 2016     Issue No. 13
Patient-Centered Care News
The other day I read this description of Patient-Centered Care which I wish to share as I think it sums it up well: "In patient-centered care, the patient is the source of control for their care. The care is customized, encourages patient participation and empowerment, and reflects the patient's needs, values and choices. Transparency between providers and patients, as well as between providers, is required. Families and friends are considered an essential part of the care team."
We hope that you find this complimentary monthly e-newsletter informative. Below are short summaries of each selected item with links to the entire pieces. Also included is a downloadable PDF version for readers who prefer that format.
Please feel free to send any questions or comments to comm@healthcarechaplaincy.org.
Rev. Eric J. Hall
President & CEO
HealthCare Chaplaincy Network & Spiritual Care Association
Thought for Today ----   An Imperative for the Chaplaincy Profession
One of the best practices that chaplaincy has long resisted is establishing standard practice. Chaplains are used to operating on intuition or "just being." Part of the resistance is that many chaplains have a misunderstanding of what standard practice is and is not. What it is not is giving up the art of chaplaincy or using the training that teaches us to respond to the other as an individual. Standard practice means that everyone knows how something is done and does not have to guess. It also means that everyone outside the chaplaincy department knows what to expect when they interact with a chaplain. Standardized practice can also mean that the chance of a process going wrong will be reduced or eliminated. It is time to move forward.
Spirituality and Health Care

Spiritual Advice for Surviving Cancer and Other Disasters (Washington Post)
An oncologist briskly walks into the consultation room, greets me and my wife, double-checks his chart and pulls up a computer image.

"It's cancer," he says.

As the shock starts to wear off, I cry. My oncologist tries to engage me in small talk. "What is it you do for a living?" he asks. I inform him that I'm a college professor and that I do disaster research.

After a slight pause, he replies, "Looks like you're in for your own personal disaster."
Experiences and Expressions of Spirituality at the End of Life in the Intensive Care Unit (ATS Journals)
Background: The austere setting of the intensive care unit (ICU) can suppress expressions of spirituality. Objective: To describe how family members and clinicians experience and express spirituality during the dying process. Setting: 21 bed medical-surgical ICU Methods: Reflecting the care of 70 dying patients, we conducted 208 semi-structured qualitative interviews with 76 family members and 150 clinicians participating in the 3 Wishes Project. Interviews were recorded and transcribed verbatim. Data were analyzed by 3 investigators using qualitative interpretive description.
Patient Experience
A Nurse Writes ----     4 Ways Nurses Can Indirectly Influence Patient Experience (HealthLeaders Media) 
  1. Acknowledge Patients' Suffering
  2. Create 'Radical Convenience'
  3. Apply the '90/5' Rule
  4. Appreciate Your Staff
A Physician Writes ─ 5 Ways to Improve  Physician-Patient Relationships (H&HN-Hospital & Health Networks)

Improved efficiency and effective patient engagement are often treated as if they are mutually exclusive. But through my experience as a physician and instructor, I have seen the power that several simple but fundamentally important skills can have on the physician-patient relationship. Rather than being an inevitable casualty of the changing health care environment, patient engagement is the road to improved efficiency, quality, safety and financial stability. Equipping everyone with the skills needed for success will improve culture, quality, patient experience, and provider and staff satisfaction as well as reduce physician burnout.

Your health care team members need five skills to restore relationships in their own practices:
  1. Presence and mindfulness.
  2. Reflective listening.
  3. Information gathering and agenda setting.
  4. Recognizing and responding to emotion.
  5. Gratitude and appreciation.
Taking the time to listen leads to better outcomes.

Palliative Care

Palliative Care Targets Quality of Life (Kiplinger)
This is an excellent overview article to give to those unfamiliar with palliative care facts and benefits. Includes perspective from cancer patient Amy Berman of The Hartford Foundation ("Palliative care is the best friend of the seriously ill."), Dr. Diane Meier, director of the Center to Advance Palliative Care ("Palliative care is appropriate at any age and at any stage in a serious illness and can be provided along with curative treatment."), and Judith Skretny, director of palliative care for the National Hospice and Palliative Care Organization ("Palliative care can be given to people anywhere.")
New Edition of Pediatric e-Journal Focuses on Communication (National Hospice & Palliative Care Organization & e-Hospice USA e-newsletter)

Communications with children and families is the theme of the new edition of the pediatric e-journal produced by NHPCO's Children's Project on Hospice/Palliative Services. This PDF resource is available free of charge online.

These articles included in this edition of the e-journal offer suggestions for and examples of engaging in this important aspect of providing pediatric palliative/hospice care.

Early Palliative Care Recommended for Cardiovascular Disease and Stroke Patients (AAHPM SmartBrief and tcdmd)
Patients with advanced cardiovascular disease and stroke should receive early palliative care, the American Heart Association and American Stroke Association said in a policy statement in the journal Circulation. The report included 28 recommendations to facilitate use of palliative care, covering reimbursement for services, the identification of patients who need palliative care, the creation of quality measures, the development of standards for hospital palliative care and education and certification for practitioners.
Systematic Palliative Care Provides Greater Improvement in Quality of Life for Patients with Pancreatic Cancer (Oncology Nurse Advisor)

Quality of life is significantly improved for patients with pancreatic cancer when systematic palliative care is administered vs on-demand palliative care, a study published in the European Journal of Cancer has shown.

Early palliative care (EPC) is proven to have a positive impact on clinical outcomes for oncology patients; therefore, researchers sought to determine optimal timing for EPC activation in a prospective, multicenter randomized study. 

Read more
End-of-Life Care
A Physician Writes ----   Mission Creep Doesn't Benefit Patients at the End of Life (Washington Post)

When my father was 88 and the picture of health for his age, he taught me, an experienced physician, an unexpected lesson.

We were discussing treatment options promoted by his primary-care physician and other doctors for an aortic aneurysm - a ballooned segment of blood vessel at risk for dangerous rupture in his abdomen. He turned to me and asked, "Why would I want to fix something that is going to carry me away the way I want to go?"

My father had the generally accurate impression that if his aneurysm ruptured, he could demand pain medicine, decline emergency surgery and be dead from internal bleeding within a few hours or, at most, a day or two.

With his unexpected question, he directly challenged the assumption that a doctor's advice is always in a patient's best interest, particularly regarding a medical problem late in life. This proposition had been my general belief, but after more than two decades as an internist and gastroenterologist, he had prompted me to reconsider it.

Furthermore, Dad was making an important distinction, between care at the end of life (in this case, palliative care for pain) and treatment (aneurysm repair). He was also suggesting a natural exit strategy. Not suicide, to which he had a moral objection, and not physician-assisted suicide, which was not a legal option in his home state of Wisconsin.

Despite his generally decent health, we both thought that he was too old for a major surgical repair, so I suggested he undergo an outpatient procedure to insert a stent to prevent the ballooning artery from worsening - that would at least postpone the threat of rupture. My reasoning was that with the stent, he was likely to enjoy the birth of his first great-grandchild and that without it, he would probably never know her.

My father lived five more years and met 12 great-grandchildren. Three of those years were good ones, but two of them were not.

I have asked myself, "Was it worth it?" I know that he asked himself that, too. His mantra for the last two years of his life was "I have lived too long."

Four Things Dying People Agree are as bad as or Worse Than Death 
(AAHPM SmartBrief and Quartz) 

Among seriously ill patients asked to consider dying or living with limitations, 69% said being incontinent would be as bad or worse than death, while 67% cited needing a breathing machine, 56% listed having a feeding tube and 54% said it was requiring constant care. Researchers noted in JAMA Internal Medicine that none of the patients had those limitations and it was possible they overestimated how difficult it would be to live with them.

Read more
"More At Peace": Interpreters Key to Easing Patients Final Days (National Hospice & Palliative Care Organization, e-Hospice USA e-newsletter and Kaiser Health News)
Interpreters routinely help people who speak limited English ----     close to 9 percent of the U.S. population, and growing ----     understand what's happening in the hospital. They become even more indispensable during patients' dying days. But specialists say interpreters need extra training to capture the nuances of language around death.

Many doctors and nurses need the assistance of interpreters not only to overcome language barriers but also to navigate cultural differences. Opportunities for miscommunication with patients abound. Words don't always mean the same thing in every language.

Medical staff, already nervous about delivering bad news, may speak too quickly, saying too much or too little. They may not realize patients aren't comprehending that the team can no longer save their lives.

"That's when it gets interesting," Maldonado said. "Does the doctor understand that the patient isn't understanding?"
Read more
Important Webinars Coming Up In September-October

September 15th and October 19th: Free Live Q&A Forums About the New Spiritual Care Association hosted by prominent health care chaplains the Rev. Sue Wintz, BCC and the Rev. George Handzo, BCC
Register for October 19th Forum

October 25th: "Advocacy for Spiritual Care in a Changing Political Environment" presented by Washington, DC expert M. Todd Tuten ─ Senior Policy Advisor, Akin Gump Strauss Hauer & Feld LLP 

October 27th: "Reforming Chaplaincy Training" presented by The Rev. David Fleenor, BCC, ACPE Supervisor, Director of Clinical Pastoral Education, Mount Sinai Health System 
Board Certified Chaplains: September 15th Is Deadline to Purchase at Reduced Price the New Standardized Clinical Knowledge Test

Three New Online Professional Education Courses Now Available at the Spiritual Care Association Learning Center

   August 2016     Issue No. 12
Patient-Centered Care News
While all of the articles selected for this issue address an aspect of patient-centered care, I wish to draw your attention to four in particular that directly speak to spirituality in health care:
  • A Physician Writes: How Spirituality Can Help Motivate Patients
    (from KevinMD)
  • A Chaplain Writes: A Mindfulness Prayer to Begin Interdisciplinary Team Meetings (from Pallimed)
  • Profile of a Hospice Nurse: A Tender Hand in the Presence of Death
    (The New Yorker)
  • Profile of a Hospital Chaplain Who Serves Both a Hospital in Oregon and a Clinic That He Founded in Uganda (KATU-TV)
Chaplains, who deal with stressful situations, practice spiritual self-care for their own well-being. Recently, I was prompted to write in The Huffington Post about how spiritual self-care ─ in whatever way is personally meaningful ─ can be important for any of us. The link to that article is included here, too.

We hope that you find this complimentary monthly e-newsletter informative. Below are short summaries of each selected item with links to the entire pieces. Also included is a downloadable PDF version for readers who prefer that format.
Please feel free to send any questions or comments to comm@healthcarechaplaincy.org.
Rev. Eric J. Hall
President & CEO
HealthCare Chaplaincy Network & Spiritual Care Association
Thought for Today ----    An Imperative for the Chaplaincy Profession
Professional health care chaplains, while caring for the emotional and spiritual needs of individuals regardless of religion or beliefs, are laser-focused on upholding the humanity of the patient. Now more than ever, they must also look beyond the bedside. In today's health care environment, they must consider the expectations of health care settings ----    most of all, mounting pressure on all disciplines to contribute to metrics such as patient satisfaction, patient experience, medical outcomes, and cost savings. Value derived from quality outcomes is paramount. These facts of contemporary medicine place professional chaplaincy at a critical crossroads. It is time to move forward.
A Physician Writes: How Spirituality Can Help Motivate Patients (KevinMD)
Recently, I was asked to give a talk on spirituality and its importance in health care. I found myself thinking about how I have spent the last few years focusing on the "easy" fixes with my patients such as diet, sleep, and exercise. Now, I am not saying that these things are truly easy to fix.

However, when it comes to a physician addressing these topics with a patient, talking about the evidence on how certain foods can contribute to or prevent disease and giving specific recommendations based on current science, is much easier than talking to a patient about spirituality and how it can also contribute to or prevent disease.

A Chaplain Writes: A Mindfulness Prayer to Begin Interdisciplinary Team Meetings (Pallimed)

I am a hospice chaplain working in Central Ohio and am asked in that role to provide a prayer at the beginning of our interdisciplinary team meetings. I want the prayer to be truly interfaith and non-denominational, but even more importantly, I want the prayer to meet the team where it is in the moment, and to inspire them in their work. I use a mindfulness bell to set the tone for the prayer and to create a space in the day.
Hospice and Palliative Care
Profile of a Hospice Nurse: A Tender Hand in the Presence of Death (The New Yorker)

The daily work of a hospice nurse, who treats the physical, psychological, and spiritual needs of people at the most vulnerable point of their lives. 

Heather Meyerend is a hospice nurse who works in several neighborhoods in South Brooklyn-Sheepshead Bay, Mill Basin, Marine Park, Bensonhurst, Bay Ridge. She usually has between sixteen and twenty patients, and visits each at home once a week, sometimes more. Some patients die within days of her meeting them, but others she gets to know well, over many months. She sees her work as preparing a patient for the voyage he is about to take, and accompanying him partway down the road. She, like most hospice workers, feels that it is a privilege to spend time with the dying, to be allowed into a person's life and a family's life when they are at their rawest and most vulnerable, and when they most need help. Some hospice workers believe that working with the dying is the closest you can get on earth to the presence of God.

Campaign Seeks to Increase Palliative Care Conversations, Referrals (AAHPM SmartBrief & Healio)

The National Institute of Nursing Research's Palliative Care: Conversations Matter campaign is aimed at increasing the number of pediatric palliative care conversations and referrals earlier in the treatment process, said director Patricia Grady. The campaign offers written materials about palliative care for families of seriously ill children.

The 11 Qualities of a Good Death, According to Research (Quartz)

A recent study published in the American Journal of Geriatric Psychiatry, which gathered data from terminal patients, family members and health care providers, aims to clarify what a good death looks like. The literature review identifies 11 core themes associated with dying well, culled from 36 studies:
  • Having control over the specific dying process
  • Pain-free status
  • Engagement with religion or spirituality
  • Experiencing emotional well-being
  • Having a sense of life completion or legacy
  • Having a choice in treatment preferences
  • Experiencing dignity in the dying process
  • Having family present and saying goodbye
  • Quality of life during the dying process
  • A good relationship with health care providers
  • A miscellaneous "other" category (cultural specifics, having pets nearby, health care costs, etc.)
In laying out the factors that tend to be associated with a peaceful dying process, this research has the potential to help us better prepare for the deaths of our loved ones-and for our own.

A Doctor Focused on Dying Finds Lessons for Better Living (e-Hospice International and Stat)
Dr. BJ Miller, senior director of the Zen Hospice Project in San Francisco, knows most people regard hospice and palliative medicine with a sense of dread, instead of possibility. Hospice and palliative medicine specialists frequently speak about their field needing an image makeover. He is poised to deliver it.
Fast Food-Style Palliative Care Consults Found Ineffective, May Cause PTSD (Geripal)
Why were PTSD symptoms WORSE with the palliative care intervention?

Doug White writes a terrific accompanying editorial outlining several possible explanations for these findings. The main one I want to highlight is this: "The intervention was not a full palliative care consult, which typically involves more frequent encounters with palliative care practitioners, active management of patients' symptoms, and involvement of social workers and chaplains."

Exactly. With all due respect to the outstanding palliative care clinicians at Mt. Sinai and Duke, these were not full palliative care consults. They were "In-N-Out fast food-style" palliative care consults (Google In-N-Out, East Coasters).

An average of 1.4 encounters, and on the very first encounter you cover prognosis and goals of care? I do that every once and awhile, but my primary goals in the first encounter are usually (1) to introduce the idea of palliative care; and (2) to form a relationship with the patient or surrogate: Who are you? Where do you come from? How are you?

I try very hard not to get into the heavy stuff of discussing prognosis until I know the person and have formed a relationship. I try to encourage people to involve palliative care early in the process, prior to 7 days on a ventilator, as a great deal of the important work (and sometimes misinformation) has already happened.

And when I'm consulted about one of these patients, I work together with the ICU team, often meeting with family in conjunction with the ICU residents, fellows, attendings, social workers, and chaplains. I'm part of a team, and it's important for patients and family members to see it that way. In this study, the ICU docs hardly ever saw surrogates together with the palliative care intervention group (less than 10% of the time).
Profile of a Hospital Chaplain Who Serves Both a Hospital in Oregon and a Clinic That He Founded in Uganda (KATU-TV)
Father Freddy Okun is the Director of Spiritual Care at Providence St. Vincent Medical Center in Portland, Oregon. He came to the hospital by way of Nebbi, Uganda, where he lived until the turn of the millennium.

"[Patient] stories are very powerful to people going through losses," he said. "I had losses in my family so hearing their stories makes me feel the losses that I had in my own life as well."

When Father Freddy was young, his father and sister both contracted malaria and died.

In 2009 Father Freddy helped open a clinic in Nebbi, the only one in that part of the country equipped to treat serious illnesses.

"Still people die of malaria [in Nebbi], but there are so many wonderful stories of people who have been healed due to that clinic," Father Freddy said.

Teams from Providence have played a major part in that healing. Father Freddy has helped bring doctors and nurses from Providence to Uganda to both train medical staff there and see patients, sometimes hundreds of them in a matter of days.

Read more
Patient Experience
Customer Service vs. Patient Care (Patient Experience Journal & The Beryl Institute)

In a competitive market where financial resources are limited, many of the popular approaches to improving the patient experience involve large capital investments in such things as hotel style amenities and expensive technology. The author argues that marketing based on a model of the patient as a traditional 'customer' is ill conceived and contributes unnecessarily to the high cost of healthcare while lacking a true understanding of, or an appropriate response to, the most basic needs of hospitalized patients that lead to patient satisfaction.

Read more
Taking Time Out for Spiritual Self Care (The Huffington Post)

While walking along Broadway in Lower Manhattan recently, I noticed a group of young adults handing out booklets and inviting passersbys to a prayer station set up on the sidewalk. Some people stopped and engaged in conversation, while others avoided contact by crossing to the other side of the street. I was intrigued by this and wondered, "How do people view spiritual care? What feels comfortable -or uncomfortable - about something we all need?" The fact that many people did stop at the prayer station certainly indicates a strong need.

Read more

New Online Professional Continuing Education Course 
Added to the Spiritual Care Association Learning Center
What We Do Matters: Continuous Quality Improvement (CQI) within Chaplaincy and Health Care
This course is designed to enable learners to be a full participant in CQI processes and to establish and sustain a CQI program for a chaplaincy or spiritual care service using Lean and Six Sigma. Participants will learn the basic language in order to recognize CQI's underlying assumptions, language, and processes. The course will teach assumptions and language that are pretty much universal to all CQI systems and the language particular to Lean Six Sigma which is the most widely used system. Participants will learn how to set up and run simple Lean or Six Sigma projects and be able to avoid the most common mistakes in this process. Examples from hospital practice will be provided. (Course Author: The Rev. George Handzo, BCC, CSSBB) 

Health Care Providers: Show the World That You 
Deliver Excellent Spiritual Care

Chaplaincy Job Opportunities in Israel

Kashouvot, a pioneer organization in Israel that is advancing multifaith spiritual care, seeks Christians or Muslims for paid chaplaincy work in Israel. For more information contact Rabbi Miriam Berkowitz at kashouvotmiriam@gmail.com.
Thought for Today ---   An Imperative for the Chaplaincy Profession

Other health care disciplines utilize evidence-based tools as a framework for care. Increasingly, all services are being judged ----    and funded ----    by the value of what they add to the system with value defined as Quality/Cost. In the U.S., the major quality goals are known as the "triple aims": improved medical outcomes, reduced cost, and patient satisfaction. Applying evidence-based tools must be an imperative for the chaplaincy profession to be on par with other health care professions.
Summer/Fall Catalogue of Spiritual Care Educational Offerings
Keeping with the above thought, HealthCare Chaplaincy Network (HCCN) and the Spiritual Care Association (SCA), HCCN's affiliate that is a multidisciplinary professional membership organization, have a wide range of educational offerings to enhance your professional practice and to advance the field of spiritual care. 
Evidence-based knowledge informs these offerings, and will continue to be the foundation for those that we introduce in the future.

Our summer/fall catalogue of spiritual care educational programs and products includes: 

The summer/fall catalogue is below.  My colleagues and I hope that you find this useful.  Please watch for additional offerings in the coming months.
Peace & Blessings!
Rev. Eric J. Hall
President & CEO
HealthCare Chaplaincy Network and
Spiritual Care Association
July20July 20th Deadline: Last Call to Apply for the New Spiritual Care Fellowship in Palliative Care

SCA will begin offering a Spiritual Care Fellowship in Palliative Care for board certified chaplains currently working in a hospice or palliative care setting.  It is designed to increase competencies and best practices in caring for people who are seriously or chronically ill, and their caregivers, at a time when palliative care is expanding rapidly in the U.S.  It will be offered twice per year, beginning in September and January, with four to eight selectively-chosen participants in each cohort.  The deadline for the first session is July 20th.

  • The year-long fellowship is an online, cohort-based program built upon an academically rigorous and best practice-informed curriculum.
  • Upon completion, fellows will demonstrate competency in intermediate or advance-level practice according to the competency guidelines for professional chaplains who provide palliative and end-of life care.
  • The educational program will prepare fellows for specialty certification in palliative/hospice care by certifying bodies, including SCA.
  • Each fellow will be supervised by a board certified hospice and palliative care chaplain and interdisciplinary team member/on-site supervisor, and participate in weekly, live video conferencing classroom sessions.
  • Learning activities include simulated patient/family interaction role-play, interdisciplinary team building exercises, case presentations, journal article and book reviews, an interdisciplinary team presentation, a quality improvement project, and a publication-ready capstone project.
  • The program was developed by HCCN and is being made available through SCA.
For more information, please contact: fellowships@spiritualcareassociation.org
July28July 28th: Webinar on What Patients Want & How a Patient-Centered Approach to Care Delivers
As part of HCCN's ongoing series of continuing education webinars, we will be offering a webinar on "What Patients Want & How a Patient-Centered Approach to Care Delivers" on July 28th. Our presenter is Sara Guastello, Director of Knowledge Management of Planetree, a global leader in advancing patient-centered care.

The webinar qualifies for 1.5 Continuing Education Hours, and is intended for health care chaplains, health care providers, and other interested professionals. It will take place from 1:30 - 3 p.m. ET.
Sept14September 14th: New Sessions Starting for Online Chaplaincy Palliative Care Certificate Courses (Fundamentals and Advanced Levels)
Two more sessions will begin on September 14th of HCCN's popular palliative care certificate courses offered in conjunction with California State University Institute for Palliative Care. The online courses are available at two different levels: fundamentals and advanced.

The fundamentals course is ideal for board certified and non-board certified chaplains as well as other care providers interested in spirituality practice in palliative care.

The advanced course is ideal for:
  • Chaplains who have completed the fundamentals course who want to build upon that knowledge base and continue to develop their skills to improve patient outcomes.
  • Board certified chaplains wishing to enhance preparation for a specialty certification from a professional chaplaincy association.
  • Department directors who meet the course requirements and desire to build upon their expertise and contributions to the palliative care team. 

More than 700 chaplains and other spiritual care providers to date have completed and highly praised these certificate courses. For instance, one student said: "I believe future students will be amazed by the new skills they will have gained by the completion of the course. I am one of them."

Sept15September 15th Deadline: Reduced Fee Offer to Take New Online Test of Chaplaincy Care Knowledge

HCCN is offering all board certified chaplains the opportunity to take, through its SCA affiliate, the online test of knowledge and understanding of evidence-based chaplaincy scope of practice, and receive the test prep materials ─ at a significantly reduced cost for a limited time.

The regular full cost for the test prep materials and the online test is $570.
HCCN will pay three-quarters of the cost. Your price for a limited time: $150.

This purchase offer expires September 15, 2016.

When you pass the test, you will receive a certificate that attests that you have demonstrated knowledge in chaplaincy, based on the latest evidence and an objective assessment. This helps standardize and modernize the profession.
To take advantage of this limited-time offer:
  • You do NOT have to be a SCA member.
  • You do NOT have to give up your board certification from another chaplaincy certifying organizaition.
Why is HCCN making this offer?

We believe it elevates and adds credibility to professional chaplaincy, contributes to improvement in the delivery of spiritual care, and demonstrates value by:
  • Providing an objective assessment of a chaplain's knowledge of the first evidence-based chaplaincy scope of practice developed by a multidisciplinary, international panel of experts.
  • Evolving chaplaincy similar to how other health care professions regularly adjust their standards based on emerging research, the growing complexity of health care, and other factors.
The Test   ----    What and Why? 
  • This type of test is standard practice in medicine, nursing, and other health care disciplines ----    putting chaplaincy on par with colleagues.
  • It is being developed using subject matter experts and the most rigorous standards, and will be able to be scored objectively. 
  • The knowledge to be tested will be made public, thus allowing chaplains to fully prepare without any uncertainty about the content to be tested. For example, modules in the test include health care ethics, basics of world religious/spiritual systems, and spiritual assessment models.
  • An individual chaplain's test results are confidential.
The test and prep materials will be available this September. We will inform you when they become available, and you can take the test any time after that.
Purchase here before September 15th to take advantage of this offer.
OnlineOnline Learning Centers Adds 11th Course: "When It's Time to Say Goodbye: Introduction to Spiritual Care at the End of Life"
SCA has added its latest course to the Spiritual Care Association Online Learning Center ----    raising to 11 the number of courses that are currently available. 

The latest course is entitled "When It's Time to Say Goodbye: Introduction to Spiritual Care at the End of Life." This course is intended for those who are new to, unfamiliar with, or wish to learn more about end-of-life issues in order to inform their care for all persons. It discusses various aspects of end-of-life care, including the dying process and physiological changes, advance care planning, conflicts that may occur between dying persons and families, palliative care, and hospice. It will also identify Issues of emotional and spiritual, religious and existential distress, as well as appropriate interventions, cultural, religious, spiritual and existential practices, and care of the family. (Course author: The Rev. Sue Wintz, M.Div., BCC ─ 35 hours & 1 Credit)

All courses in the Online Learning Center are based on the new, standardized evidence-based scope of practice and evidence-based quality indicators developed by two interdisciplinary panels of experts, convened by HCCN, from the fields of chaplaincy, medicine, nursing, psychotherapy, palliative care, social work, research and policy in the U.S. and overseas. These courses are for chaplains and other spiritual care providers, and other types of health care professionals, such as doctors, nurses and social workers.
SubscribeSubscribe to PlainViews  ---   The Monthly Preeminent Online Professional Journal
PlainViews is a monthly publication that provides a place for professional chaplains and other care providers to find, present and discuss information in accordance with the publication's mission to translate knowledge and skills into effective chaplaincy practice and care for the human spirit.
Issues include research articles, clinical experiences, and current events along with regular features, such as News and Journal Watch, and Ask the Chaplain, a brief interview on issues we need to address.
Here's a typical comment from a subscriber: "I wish that I had more time during my professional day to read, but always find the time for PlainViews because it is relevant and helpful to my work." 
TrainTrain Volunteers With Popular Manual 

Expanding the reach of chaplaincy while managing the budget is on every director's mind. Engaging lay or clergy volunteers can be one tactic; however, for this approach to work, effective volunteers require baseline training. That's why HCCN created a comprehensive chaplaincy volunteer training manual, "Chaplaincy Care: Volunteer Training Manual," for use in any health care setting.

Here's a representative comment about the manual from one director: "I am going to be running a volunteer pastoral care training program. I love the Chaplaincy Care Volunteer Training Manual. It's clear, succinct and fabulous. We serve a wide variety of faiths, so this is perfect."

ReadRead the Latest Edition of Caring for the Human Spirit Magazine

The current issue (spring/summer 2016) of HCCN's Caring for the Human Spirit Magazine includes a special section on grief, with articles that can help chaplains and other health care providers in their provision of high-quality spiritual care. The biannual magazine educates and informs its readership of the latest evidence-based best practices, skills, and other developments in the spiritual care field, to enhance whole person care ----    body, mind and spirit. 

The latest issue also looks at:
  • Talking to Kids About Death & Dying
  • Game-Changer: Evidence-Based Quality Indicators
  • Spritual Care Can Drive Patient Experience
  • Jewish Hospital's Hybrid Spiritual Care Model
  • How New Depression Screening Guidelines Impact Chaplains
  • Palliative Care Progress in Mongolia
Complementing the print and online editions of the magazine, HCCN's website includes video interviews with some of the authors in which they expand upon their article topics. The next issue (fall 2016/winter 2017) will be published in late October.

RegistrationRegistration Will Open in the Fall for Fourth Annual Caring for the Human Spirit Conference ----    March 13-15, 2017
Registration will open in the fall for HCCN's fourth annual Caring for the Human Spirit Conference ----    a content-rich scientific and educational event that will take place in Chicago on March 13-15, 2017. 

As in the past, the 2017 conference ----    also available via webcast ----    will present first-class speakers and workshops focusing on the integration of spiritual care in health care. The first three conferences have been great successes, drawing a diverse audience of chaplains, physicians, nurses, social workers, psychologists, researchers, administrators, students and others from around the world.

Beth Delaney, a nurse practitioner and assistant professor of nursing, said of this year's conference: "As a nurse practitioner who cares for cancer patients, my nurse research partner and I found attending the Caring for the Human Spirit conference provided a forum for 'like-minded' health care individuals to form a community of inquiry, where learning and supporting one another encourage all of us to continually strive to improve the care for one of the most unique characteristics of all humans ... the spirit."

For more information about registration, as well as exhibitor/supporter opportunities, click here.
First-of-Its-Kind Advocacy Initiative in Washington, DC

The Spiritual Care Association (SCA) has retained Akin Gump Strauss Hauer & Feld LLP, a leading international law firm, to spearhead advocacy efforts aimed at raising the bar on spiritual care and further integrating it into the U.S. health care system.

Leading the effort will be M. Todd Tuten, a senior policy advisor in the firm's Washington, DC office who has extensive congressional and private-sector experience, including the development and implementation of substantive policies and strategies on a broad range of legislative and regulatory matters, with a particular focus on health care. He is actively engaged in the debate on proposals to strengthen Medicare, Medicaid, and the nation's health care system.

SCA is fortunate to have secured such a well-respected firm. This paves the way for the first time for spiritual care stakeholders to build a united and loud voice on Capitol Hill around this important aspect of whole-person care. We must amplify spiritual care issues in the public interest in order to move the profession forward and, moreover, to assist countless people in need.

SCA plans to educate and engage federal legislators and policymakers with the intent of securing laws, policies, reimbursements and resources that support quality spiritual care for individuals and their family caregivers throughout the continuum of care and in all types of health care settings. We welcome your participation in this important effort. If you wish to be involved, please send a message to info@spiritualcareassociation.org with the word "Advocacy" in the subject line and your contact information.

Read the full announcement about this initiative here.

Unprecedented Collaboration Within the Chaplaincy Profession Is Well Underway 

When I announced the formation of the Spiritual Care Association in April, I stated that SCA was committed to inviting collaboration with the many chaplaincy organizations to advance the profession. Our invitations to collaborate have been received with enthusiasm. Over these past two and a half months, on behalf of SCA, I have had highly constructive conversations with many of the chaplaincy certification or accreditation organizations - 11 total so far ─  to discuss if and how the SCA's educational, certification, and advocacy resources could be of value to their members. The overall answers have consistently been "yes" and the discussions of "how" are ongoing. Also, last week we held a group conference call with many of these associations about collaborating in a unified way to benefit the chaplaincy field. To the best of our knowledge, this is the first time that this many chaplaincy associations have participated in such a collective meeting. We continue to invite others to join the conversation.

Since effective spiritual care should involve participation, in some way, of all members of the interdisciplinary health care team, SCA was founded as a multidisciplinary organization to include not only chaplains, but also nurses, social workers, physicians, and others, plus non-chaplain clergy. I can report that we already have up and running advisory committees consisting of nurses and social workers, respectively, and we are forming a physicians' committee. We are also working with a number of major seminaries across the U.S. to serve their constituents.
Many SCA Members Have Volunteered to Serve on Committees

After inviting SCA members two weeks ago to serve on one or more committees in formation, more than 70 members have said they wish to do so. The committees include:
  • Advocacy
  • Clinical Chaplaincy
  • Certification & Credentialing
  • Education
  • Hospice & Palliative Care Chaplaincy
  • Pediatric Chaplaincy
  • Research
Agendas for each committee are being developed with activity to heat up in September. If you are an SCA member and are interested in serving on a committee, please send an email message with the word "Committee" in the subject line to info@spiritualcareassociation.org and include your contact information and what committee(s) are of interest. A reply to you with more information will be forthcoming.

A Personal Note

My SCA colleagues and I are very grateful for all the enthusiastic support that we have received from the spiritual care community in the U.S. and other countries, and the rapid growth of membership. Consistent with our commitment to open dialogue, please feel free to contact me via info@spiritualcareassociation.org if you have any questions, want to know more about SCA or wish to have a conversation.
Peace & Blessings!

Rev. Eric J. Hall
President & CEO
HealthCare Chaplaincy Network and
Spiritual Care Associati
   June 2016     Issue No. 11
Patient-Centered Care News
We hope that you find this complimentary monthly e-newsletter informative. Below are short summaries of each selected item with links to the entire pieces. Also included is a downloadable PDF version for readers who prefer that format.
Please feel free to send any questions or comments to comm@healthcarechaplaincy.org.
Rev. Eric J. Hall
President & CEO
HealthCare Chaplaincy Network & Spiritual Care Association
Spiritual Care Research Update
Members of HealthCare Chaplaincy Network's (HCCN) Research Advisory Board met by conference call last week to discuss the state of research in spiritual care and the field of professional chaplaincy. It was agreed that much has been accomplished in the past decade to affirm and validate the impact of spiritual care and the contribution of chaplains. While the research has been formidable, significant gaps still remain. HCCN is committed to contributing resources and creating the infrastructure to drive the research agenda forward. Next steps include identifying:
  • Other organizations and researchers in the field to involve in this important effort.
  • An agenda of research topics to initiate data collection pilot projects 
If you are interested in participating, please send an email and some detail to comm@healthcarechaplaincy.org with the word "Research" in the subject line. 
Spiritual Care & Nursing
What Nurses Want: More Guidance on Spiritual Care (HealthLeaders Media News & American Journal of Critical Care)
A recent study on nurses' definitions of spirituality and their comfort-levels with providing patients spiritual care has led a Cleveland Clinic research team to create a working definition for spirituality in healthcare.
The article "Critical Care Nurses' Perceived Need for Guidance in Addressing Spirituality in Critically Ill Patients," was published in the May 2 edition of the American Journal of Critical Care.
"Without a clear definition, each nurse must reconcile his or her own beliefs within a framework mutually suitable for both nurse and patient," said lead author Christina M. Canfield, RN, MSN, ACNS-BC, CCRN-E, in a media release. "Nurses who seek to give whole-person care to their patients' sense that something beyond the technical aspects of their job is needed."
She is a program manager, Cleveland Clinic Hospital and clinical nurse specialist at Cleveland Clinic's main campus.
Through interviews with 30 nurses, researchers found that even though nurses report they are ready to offer direct spiritual support if they sensed it was needed, they had trepidation about initiating spiritual support for fear of potentially offending the patient or the patient's family.
Nurses also said they were eager for resources and guidance on how to address their patients' spiritual care needs.

Read more here and here.

A Patient Writes
10 indispensables for those with chronic pain and illness (KevinMD.com)
 1. Email. 
 2. Being nice to yourself. 
 3. Pacing. 
 4. Earplugs. 
 5. The proper pillow arrangement. 
 6. Not sweating the small stuff. 
 7. Slowing down. 
 8. Amazon's Subscribe and Save (or its equivalent). 
 9. Spinach. 
10. Saying "no." 

A Family Caregiver Writes
This Is What I Learned, Living in an Intensive Care Unit (Huffington Post)
Recently I had the rare and shocking privilege of living in an Intensive Care Unit, or ICU, for three months. I was not a patient, nor a member of staff. I was there because my teenaged son became critically ill. Tim's learning difficulties meant that he needed his dad or me to be with him virtually all the time. I stayed every night for the first month, and then around five nights a week thereafter. ...
During those three months, I learned that crisis means looking after yourself as well as doing your best to help others. Specifically, I learned the following five insights.
  1. Appreciate and care for your body.
  2. Pause, breathe. Sit still in silence every day.
  3. Give healing when you are drawn to do so.
  4. Choose uplifting language.
  5. Adopt a mindset of wellness.

Physicians Write

Here are the lessons I learned from caring for my ailing father (KevinMD.com) 
My father's illness taught me to be a more humanistic and compassionate physician. Our patients and their families are scared and confused. It is not only our job to know anatomy in the operating room, clinical guidelines, or how to manage fluids and antibiotics; to truly heal a patient, we must understand what they're dealing with along the entire course of an illness. I know that my father's situation was not unique, but it forced me to confront the way that I practice medicine and forever shaped the way that I treat my patients.

Read more
A physician's view on when to get more information from your doctor (The Guardian)

Diagnoses are often just educated guesses, and prognoses less certain still. Based on data collected about cancer patients over the past four decades, doctors can talk about the odds of survival. For example, we know that a patient who has localised bladder cancer has about a 70% chance of being alive at five years. But oncologists telling patients that they have a 70% chance of survival at five years is a very different thing from predicting that they have about four years left of life, as some patients with bladder cancer will decline very quickly and others will live for many years.
Such discussions entail an honest admission by clinicians that they cannot look into the crystal ball, and such statements are only meant for patients and families to weigh the risks and benefits as they make decisions about their care, because cancer treatment can often make patients very sick and reduce their quality of life.
The key to good health might lie in the ability to recognise the hype created by medical reports and how the media treats health stories and health scares. It is important to sense when to push a physician for more testing or to resist a physician's enthusiasm when unnecessary tests or treatments are offered.
With polite but firm insistence, we got the doctors to understand that this was not about their plan but my father's. We can learn from this that embracing uncertainty - and asking the right questions - allows for more humane treatment, less anxiety and better care. But to do that we need to confront some sobering realities of our modern medical system.
Read more
Listening to Patients at the End of Their Lives is Crucial - So Why Don't Doctors Do It? (The Conversation Project & The Guardian)
For many physicians around the world, end-of-life care conversations test the limits of their ability to communicate with patients. In a recent opinion piece published in The Guardian, Australian oncologist Dr. Ranjana Srivastava discusses the need to provide physicians with the training and tools that will help them have better conversations with patients about their end-of-life wishes. 
"Such training in medicine, especially when it pertains to end of life care, is patchy, undervalued and considered an optional extra rather than a clinical imperative. In an era where we have mapped the human genome and talk about cancer moonshots we have consistently failed to provide not just physicians, but all doctors, with the tools to be effective communicators."
Researchers Write
Just 5% of terminally ill cancer patients understood their prognosis, researchers say (e-hospice International, Center for Research on End-of-Life Care at Weill Cornell Medicine, Journal of Clinical Oncology)
Too many advanced cancer patients lack basic understanding about their disease, researchers report.
Only a small consortium of advanced cancer patients were able to show that they could identify and fully understand their prognosis according to a study led by faculty members from Memorial Sloan Kettering and Weill Cornell Medicine, which aimed to uncover the influence of prognostic discussions on the accuracy of illness understanding.
The open access study, published in the Journal of Clinical Oncology, compared patients' understanding of their illness before and after scans that staged their cancer, and before and after discussing results with their oncologist. Before the restaging scan visit, just nine (5%) of 178 patients acknowledged being at the end stage of incurable cancer with just months to live.
Find out what our contributing faculty members at the Center for Research on End-of-Life Care at Weill Cornell Medical College had to say about this issue.

Palliative, End-of-Life, Hospice Care
Early Palliative Care Improves Outcomes for Family Caregivers of Cancer Patients (Oncology Times)
Introducing palliative care shortly after a cancer diagnosis results in better quality of life and fewer depression symptoms for family caregivers, according to a new study.
The study (Abstract 10131) was featured in a press briefing and will be presented at the 2016 American Society of Clinical Oncology (ASCO) Annual Meeting.
"The benefits of early palliative care extend beyond patient outcomes and positively impacts family caregivers. Early integration of palliative care for patients with newly diagnosed lung and GI incurable cancers leads to improvement in family caregivers' depression and aspects of quality of life," said lead author Areej El-Jawahri, MD, Director of Bone Marrow Transplant Survivorship Program at Massachusetts General Hospital Cancer Center, Boston.
"This study suggests that early palliative care creates a powerful positive feedback loop in families facing cancer. While patients receive a direct benefit from early palliative care, their caregivers experience a positive downstream effect, which may make it easier for them to care for their loved ones."
This is the first study to show that early palliative care alone for a patient with cancer can have a strong impact on family caregivers, she said.

Read more
End-of-Life Care in Hospitals Has a Long Way to Go  (Health Leaders Media)

Many doctors and patients don't talk about how to handle the pain, disability, or despair that may accompany a serious illness or imminent death. Hospital leaders can push for greater competency in advanced planning among clinicians.
Medicare may reimburse primary care physicians for end-of-life talks with patients, but those conversations between seriously ill patients and their doctors often don't occur, even when patients are being treated for serious illnesses.
A survey by the Massachusetts Coalition for Serious Illness Care shows that 85% of Massachusetts residents believe that physicians and their patients should talk about end-of-life care, but only 15% have actually had such conversations.
Working with healthcare delivery systems will be one of the coalition's most important tasks, according to Atul Gawande, the coalition's co-chair and a surgeon at Brigham and Women's Hospital in Boston.

Read more
Palliative, hospice care lacking among dying cancer patients, researcher finds (Science Daily, Stanford University Medical Center & Journal of Palliative Medicine.)

Medical societies, including the American Society of Clinical Oncology, recommend that patients with advanced cancer receive palliative care soon after diagnosis and receive hospice care for at least the last three days of their life. Yet major gaps persist between these recommendations and real-life practice, a new study shows.
Risha Gidwani, DrPH, a health economist at Veterans Affairs Palo Alto Health Economics Resource Center and a consulting assistant professor of medicine at the Stanford University School of Medicine, and her colleagues examined care received by all veterans over the age of 65 with cancer who died in 2012, a total of 11,896 individuals.
The researchers found that 71 percent of veterans received hospice care, but only 52 percent received palliative care. They also found that exposure to hospice care differed significantly between patients treated by the U.S. Department of Veterans Affairs and those enrolled in Medicare. In addition, many patients who received palliative care received it late in their disease's progression rather than immediately following diagnosis, as recommended by ASCO.

Read more
What You (i.e. Palliative Care Team Members) Can Do To Improve Quality Right Now (Palliative in Practice blog from Center to Advance Palliative Care)
Post written by Diane E. Meier, MD, Director, Center to Advance Palliative Care
I had the privilege of visiting palliative care colleagues in Melbourne, Australia in February of this year. Not only did they share some great book recommendations (Songlines by Bruce Chatwin - which includes this quote comparing western to Australian aboriginal culture: "We give our children computer games and guns...they give their children the land.") and fantastic wine and food that rivals that in my home town of New York City, but also a breathtakingly simple way to monitor quality of palliative care during your weekly team meeting.
I observed the weekly palliative care team meeting during my visit.  After "running the list" and discussing each patient on service with the whole team, Dr. Jenny Philip pulled out the spread sheet (at link) and asked everyone if they had observed any of the following among the patients they had cared for:
  • Uncontrolled pain and symptoms for >24 hours
  • Fecal impaction
  • Dissatisfaction with the team's care on the part of patients, family members, colleagues
  • Occurrence of requests for a hastened death
  • Emergency room "crash" admissions
  • Team distress
  • And others
If such an occurrence was noted, specifics were recorded and the team leader then developed a plan of inquiry, root cause analysis and remediation.
Read more
Podcast with Substantial Content about a Successful Palliative Care Program Operated by UCLA Health for the Motion Picture and Television Fund (Palliative in Practice blog from Center to Advance Palliative Care)
Interviewed are Nurse Practitioner Linda Healy and Chaplain Rabbi Arthur Rosenberg. The program was set up to help the entertainment community - inpatient, in residence care, and outpatient  - get proper care when facing serious illness and comprises geriatricians, nurse practitioners, nurses, chaplains, licensed clinical social workers, dietitians and activity coordinators. Guidance and counseling is also provided for those struggling with complex decision making about medical issues.
Rabbi Rosenberg completed the Palliative Care Chaplaincy Specialty Certificate course offered jointly by Health Care Chaplaincy Network and the California State University Institute for Palliative Care. Rabbi Rosenberg emphasizes that delivering effective spiritual care requires the professional chaplain as the specialist and the other members of the interdisciplinary team as generalists.

Caring for the Human Spirit

Emotional, spiritual needs can affect health outcomes and how a chaplain helps (The Union Democrat - Sonora, California)
A Joint Commission Study found that health outcomes can be positively affected by attempts to address emotional and psychosocial needs.
To that end, Chaplain Mario DeLise at Sonora (California) Regional Medical Center said he works with staff to give them the tools to try to help patients on a personal level.
"It's not just chaplains that can have a calming experience (with a patient)," he said. "We want to give specific tools to everybody to talk about spirituality that builds up community. Just to give them the ability to engage people in a way that works for everyone."
When DeLise talks about spirituality, it's about noticing the spiritual experience a fellow human being is going through when they are sick.
"Spirituality is often seen to include how we make meaning of life, what we find to be our purpose in life, and how we connect in meaningful ways - with ourselves and with that which is outside ourselves. Also, chaplains and others who join a sick person as a support person help remove them from isolation as we participate in what they are going through and provide compassion and empathy," DeLise said.
"One of our things is to set people at ease. Let them know they are not going through it alone. That is typically appreciated," he said. "It would probably be disingenuous to say everyone we leave is beaming in joy, but typically we have a calming effect on people."
However, there's only so much spiritual care can do, he allowed.
One patient DeLise met was "suspicious of everyone who came in."
DeLise spent some time with him, just visiting and talking for a while.
"His wife later told me that really changed things for him. He was able to feel more trust for the whole hospital team," DeLise said. "That was a noticeable, positive thing."
DeLise said another former patient had a long history of health issues.
"I just kind of gave her space to talk. She shared her story. ... Finally she just kind of paused. She said, 'You know, I think God is using this to draw me closer to himself.' I didn't say that to her," DeLise said. "When she explored her experience in the greater context of meaning, she discovered through talking. It doesn't take away her health struggles, but for her it gave her a more positive outlook."
Read more

Keeping Our Spirit in Mind (Huffington Post)
"Spirit is the essence of being human," said the late Joseph Fabry, who wrote Guideposts to Meaning and Pursuit of Meaning, based on Vicktor Frankl's existential humanistic theory known as Logotherapy. "You have a body that may become ill; you have a psyche that may become disturbed. But the spirit is what you are. It is your health core."
That health core - our life force, needs to be cared for. When someone is ill or suffering physically, it is imperative that the person's spirit is also cared for. This is why the Spiritual Care Association came into being earlier this year. When we see all that the spirit does for us, is it any wonder that we emphasize the importance of keeping it healthy?
Should you ever feel that your spirit is not in prime condition or temporarily "out to lunch," heed the words of the well-known physician, spiritualist and author Deepak Chopra. "Ultimately spiritual awareness unfolds when you're flexible, when you're spontaneous, when you're detached, when you're easy on yourself and easy on others."
Read more

New York-Area Alzheimer's Home Care Agency to Offer "Virtual" Spiritual Care by Connecting With Chaplains via Phone, Email, Video
For individuals with Alzheimer's disease and related dementias, and their family caregivers, isolation, anxiety, and existential questions often accompany this terminal brain disorder. Now, a New York-area home care agency is collaborating with HealthCare Chaplaincy Network (HCCN) to offer its clientsa direct connection toprofessional health care chaplains who can help with the emotional and spiritual distress surrounding this disease and other illnesses.
ACS Home Care LLC (Alzheimer's Care Specialists), based in Northport, NY and servicing Nassau, Queens, Suffolk, and Westchester counties, is introducing "virtual" professional chaplaincy as a value-added service to new and existing clients. The service, Chat with a Chaplain, enables patients and family members to confidentially speak to a professional multi-faith chaplain via phone, email, or video chat.
The announcement coincides with Alzheimer's & Brain Awareness Month in June. ACS specializes in Alzheimer's disease, and also serves clients with other illnesses and needs.
This is the first home care agency HCCN is collaborating with to provide the unique service, which is staffed by HCCN's professional multi-faith chaplains. Chaplains are the spiritual care specialists on health care teams; they listen without judgment and provide comfort and meaning.
Chat with a Chaplain is available to anyone, regardless of religion or beliefs, or no religion or beliefs. Clients can obtain emotional and spiritual support as well as submit prayer requests. In the face of illness, common questions include, "Why me?" or "Has God abandoned me?"
Robert Macedonio, RN, president, director of patient care services at ACS Home Care, said he expects people facing Alzheimer's disease and related dementias to especially benefit from this service.

Read more

Chaplains: Take New Knowledge Test

HealthCare Chaplaincy Network (HCCN) is offering all Board Certified Chaplains the opportunity to take ─ through its affiliate the Spiritual Care Association ─ the online test of knowledge and understanding of evidence-based chaplaincy scope of practice, and receive the test prep materials ─ at a significantly reduced cost.

The regular full cost for the test prep materials and the online test is $570.

HCCN will pay three-quarters of the cost. Your price for a limited time: $150.

This offer expires September 15, 2016.

When you pass the test, you will receive a certificate that attests that you have demonstrated knowledge in chaplaincy, based on the latest evidence and an objective assessment. This helps standardize and modernize the profession.

To take advantage of this limited-time offer:
  • You do NOT have to be a SCA member.
  • You do NOT have to give up your Board Certification from another chaplaincy certifying organization.
Why is HCCN making this offer?
We believe it elevates and adds credibility to professional chaplaincy, contributes to improvement in the delivery of spiritual care, and demonstrates value by: 
  • Providing an objective assessment of a chaplain's knowledge of the first evidence-based chaplaincy scope of practice developed by a multidisciplinary, international panel of experts.
  • Evolving chaplaincy similar to how other health care professions regularly adjust their standards based on emerging research, the growing complexity of health care, and other factors.
The Test - What and Why?
  • This type of test is standard practice in medicine, nursing, and other health care disciplines-putting chaplaincy on par with colleagues.
  • It is being developed using subject matter experts and the most rigorous standards, and will be able to be scored objectively. 
  • The knowledge to be tested will be made public, thus allowing chaplains to fully prepare without any uncertainty about the content to be tested. For example, modules in the test include health care ethics, basics of world religious/spiritual systems, and spiritual assessment models.
  • An individual chaplain's test results are confidential.
The Spiritual Care Association

For those not familiar with the Spiritual Care Association (SCA): It is a professional, multidisciplinary membership organization that has created the first comprehensive evidence-based model to define, deliver, train, and test for the provision of high-quality spiritual care. SCA has invited all chaplaincy associations and certifying bodies to aid the field through collaboration and application of the model's components for their own members.

The test and prep materials will be available this September. You can take the test any time after it becomes available.

Sign up here before September 15th to take advantage of this offer.
Peace & Blessings!

Rev. Eric J. Hall
President & CEO
HealthCare Chaplaincy Network and
Spiritual Care Associati

So appropriate to what professional chaplains do: "We do not believe in ourselves until someone reveals that something deep inside us is valuable, worth listening to, worthy of our trust, sacred to our touch. Once we believe in ourselves we can risk curiosity, wonder, spontaneous delight or any experience that reveals the human spirit." - e e cummings (hat tip to Gratefulness.org)



The Advanced Palliative Care Chaplaincy Specialty Certificate is a joint program of the California State University Institute for Palliative Care and HealthCare Chaplaincy Network.

If you are a Board Certified Chaplain or have completed the Fundamentals / Palliative Care Chaplaincy Specialty Certificate course, the Advanced course is designed to help chaplains play a strong leadership role in their palliative care team.  It teaches the skills necessary to effectively work within, lead, and enhance the effectiveness of a palliative care team:

  1. Distinguish and demonstrate ways in which chaplains assist patients and families, in partnership with the palliative team, in identifying the benefits and burdens of specific medical interventions
  1. Demonstrate and apply expertise in palliative care communication skills to assist in goal clarification in patient/family meetings
  1. Define, document, formulate goals, interventions, and plans, through a thorough spiritual assessment, that can be articulated clearly in each palliative care situation
  1. Identify, recommend, and integrate interventions in care plans to meet the needs of diverse patients/families
  1. Analyze the needs and construct assessments and interventions specific to marginalized patient populations
  1. Identify and execute best practices for incorporating chaplaincy assessment and documentation planning/continuity of care
  1. Learn to effectively lead, manage, and inspire a chaplaincy team for better patient outcomes and higher team satisfaction

This course begins June 15, 2016, and there are only a few seats left. If you’d like to reserve your spot, please call today or register online.  You must be a board certified chaplain or have completed the Fundamentals course to register for this course.

For details and to register: https://csupalliativecare.org/programs/chaplaincy-2/



   May 2016     Issue No. 10
Patient-Centered Care News
We hope that you find this complimentary monthly e-newsletter informative. Below are short summaries of each selected item with links to the entire pieces. Also included is a downloadable PDF version for readers who prefer that format.
Please feel free to send any questions or comments to comm@healthcarechaplaincy.org.
Rev. Eric J. Hall
President & CEO
HealthCare Chaplaincy Network & Spiritual Care Association
Palliative Care
Dr. Diane Meier: Palliative care may help patients live longer  (AAHPM SmartBrief & Medscape)
Research is showing that palliative care provided along with disease treatment may help patients live longer than if they get treatment alone, said Dr. Diane Meier, director of the Center to Advance Palliative Care. Two reasons may be that palliative care teams can help patients avoid unneeded hospitalizations and reduce incidents of depression, Meier said.
Read more (Medscape requires free registration to access)

Patient Experience
Patient experience: Driving outcomes at the heart of healthcare (Patient Experience Journal - published in association with The Beryl Institute)  

There is no longer a question that patient experience matters in healthcare today. It matters for those that are cared for and served and matters to all those working each and every day to provide the best in care at all touch points across the healthcare continuum. With this recognition, there too needs to be a change in mindset about patient experience itself. When addressing the topic of patient experience, the conversation is about something much broader than the "experience of care", as identified in the triple aim. The idea of experience reflects our biggest opportunity in healthcare, where experience encompasses quality, safety and service moments, is impacted by cost and the implications of accessibility and affordability, is influenced by the health of communities and populations and by both private and public health decisions that have systemic implications. A focus on experience at the broadest sense leads to the achievement of the four outcomes leaders aspire to in varying combinations in healthcare organizations around the world: clinical outcomes, financial outcomes, consumer loyalty, and community reputation. With the rapid growth in research, a diverse and expanding global community, and a shared commitment to outcomes, patient experience has now claimed its place at the heart of healthcare.
Read more 
Spirituality and Running a Hospital
The soul of healthcare: Hospital executives seek spiritual health to support leadership (Becker's Hospital Review)

Hospital and health system executives work hard to create an environment that fosters the healing process. That said, many believe the best way for an executive to do this is to ensure that they themselves are in a healthy place - not just physically, but spiritually.
Three healthcare leaders - Sister Carol Keehan, president and CEO of the Washington, D.C.-based Catholic Health Association; Ed Fry, president of executive search firm FaithSearch Partners; and Anthony R. Tersigni, EdD, president and CEO of St. Louis-based Ascension- agree that spiritual health oftentimes goes beyond religion alone.
For many healthcare executives, nurturing their sense of spirituality might include creating time each day for reflection, meditation, community service or various other activities. Although it might be easy to right off such tasks as low on the priority list, spiritual health is actually an important business strategy administrators and executives can use to become well-rounded individuals and better leaders.
Read more
Care at End-of-Life 
Saying Goodbye When Someone You Love Is Dying (Huffington Post and e-hospice international)  
Saying goodbye to a dying relative or friend - what to talk about, when, and how - doesn't come naturally to most adults. The irony: All these conversations ask of us, ultimately, is what people appreciate hearing at any time of life: words of candor, reassurance and love.
(Here are four lessons from) those who've been through the experience of saying goodbye share what felt right to them - and what they wish they'd done differently.
A new edition of the free pediatric hospice and palliative care e-journal - that continues the discussion of pediatric bereavement and care - is available online. (National Hospice & Palliative Care Organization and its e-newsletter e-hospice USA)
"Bereavement and Care, Part Two" is the theme of the new edition of the pediatric e-journal produced by NHPCO's Children's Project on Hospice/Palliative Services. This resource is available free of charge.
These articles that make up this issue offer suggestions for and examples of engaging in the important work of this aspect of providing pediatric palliative/hospice care. Because this is a huge and very important subject, we have chosen to devote two issues to these discussions. This is the second of those two issues. Part One is also available for download.

Are New York doctors talking to patients about death? Many doctors avoid mandatory discussions with dying patients about end-of-life options (Crain's NY Business)
There is a growing movement in New York to expand options for people who are terminally ill to include physician-assisted suicide. But many who support that legislation are skeptical that doctors are complying with the laws already on the books. In New York, doctors are required to help dying patients decide what they are willing to endure at the end of their lives and advise them of their options....
"People don't get evidence-based care. They get everything thrown at the disease, even if it doesn't change the outcome," said Amy Berman, senior program officer at the John A. Hartford Foundation, a New York nonprofit that aims to improve the care of older adults.
For Berman, like many, the issue is personal. She was diagnosed with terminal cancer more than five years ago. Berman, also speaking on the panel at the New York Academy of Medicine, said she was offered treatments that were unlikely to change the course of her disease, including a mastectomy and chemotherapy. She credits her decision not to accept those treatments with having survived longer than anticipated.
Physicians Write

This pediatrician learned why it's so important to listen to a parent (KevinMD)

Medicine can wear down our hearts and souls.  My journey in pediatrics has been filled with many rewarding experiences but haunting ones as well, like this one from my third year of residency.  By that final year of training, I was no longer certain medicine was really the right choice for me.  I was struggling with the notion that after almost 11 years of education, the destination was not quite what I expected.  It was during this trying time I learned one of the most important lessons of my career:  the value of trusting a mother's intuition. 
Tell Me a Real Story (Pallimed.com)

I am reading Internal Medicine: A Doctor's Stories by Terrence Holt, MD. It is an evocative book about medicine residency that had my long-dead intern-year butterflies swirling by the second page. In his introduction, he details how difficult it is to tell a patient's story without identifying that person. It's "not enough to respect the patient. As long as there's an actual, unique individual beneath that disguise, you're making a spectacle of somebody's suffering, and that's a line no one should cross. It's bad for the patient. It's not good for you the writer, either."
I would argue that it is essential to continue our story telling in medicine. And that they are real stories about real people because that's who we treat.

7 surprising things patients should know about their physicians (KevinMD.com)
Patients and families wagging their fingers and nodding their heads angrily in the direction of clinicians.  Doctors, nurses, and therapists have been accused of being incompetent, lazy, or downright cruel.
There is a basic loss of faith in the ability of our health care practitioners.
I think that the Internet plays a role.  The ability to Google one's symptoms and come up with a host of diagnoses has made the populace feel that medicine is easy.  Furthermore, the lay press and some of our own physicians and administrators decry the system as befouled by errors.  They say that we account for as much death and disability as heart disease and cancer.
While I believe that medicine requires a continuous and stringent effort to improve itself, I also think that the populace is becoming progressively fooled and brainwashed.

Research & Measurement

Implications for Spiritual Care from Recent National Quality Forum Meeting (HealthCare Chaplaincy Network)
The Rev. George Handzo, BCC, Director, Health Services Research and Quality for HealthCare Chaplaincy Network writes:
The National Quality Forum (NQF) is a not-for-profit, nonpartisan, membership-based organization that works to catalyze improvements in healthcare. One of NQF's activities is to convene multi-stakeholder Standing Committees in topical areas that are charged to review and recommend submitted quality measures for endorsement to NQF's Consensus Standards Approval Committee (CSAC). NQF endorsement is often a stepping-stone to inclusion on federally required data sets for various levels of health care providers.  These data sets are often tied to reimbursement for those providers. So this endorsement is a big deal...

Using a chaplaincy example, it might be reasonable to start by proposing the Rush spiritual screening protocol that has some validity testing already done. What would be needed in addition is (1) significantly more validity and reliability testing and (2) research evidence that using the Rush improves some particular health outcomes. It is important to note here that demonstrating that treating spiritual distress improves health outcomes is a contribution and some of that evidence does exist but this evidence is not sufficient for NQF endorsement. The evidence must demonstrate that doing the screening itself leads to improved outcomes. 
It is certainly true that few chaplains have the ability or resources on their own to do this kind of research. However, many have the ability to advocate for this kind of research in their institutions and lend their expertise to the projects. The reality is that unless and until this kind of effort occurs in our field, except in a very few instances, spiritual care quality measures will not take the place they need to occupy to help move spiritual care integration in health care forward.

Patient Engagement Survey: Improved Engagement Leads to Better Outcomes, but Better Tools Are Needed (Fierce HealthCare and NEJM Catalyst)

Most healthcare providers believe that improved patient engagement leads to better outcomes, but were divided on the best strategies to accomplish this, according to survey results published in an NEJM Catalyst blog post.

Forty-two percent of the 340 hospital or healthcare executives, clinicians and clinical leaders who responded to the NEJM Catalyst Insights Council survey, reported that less than a quarter of their patients were highly engaged in their care decisions. More than 70 percent said less than half of their patients are highly engaged. Only 9 percent of respondents reported high levels of engagement among their patients. 

"These results highlight the challenges in front of us; while having patients who are engaged with their health and with the health system is important, low rates of engagement appear to be the norm," wrote the study authors.

Read more

More About the Patient Engagement Survey

Please see below about two upcoming webinars.

Announcing the Patient Centered Care 
Spiritual Care Grand Rounds Webinar Series 
What Patients Want -- And How a Patient-Centered Approach to Care Delivers
Presented by Planetree -- 
Since 1978, the Global Leader in Advancing Patient-Centered Care
Thursday, July 28, 2016 from 1:30 PM to 3:00 PM (EDT)

Learn more and register

Free Webinar
Sponsored by the National Coalition for 
Hospice and Palliative Care
"Medicare Access and CHIP Reauthorization Act (MACRA) and the Palliative Care Provider" 
Wednesday, June 8, 2016
Speakers are:
  • Joe Rotella, MD, MBA, HMDC, FAAHPM (American Academy of Hospice and Palliative Medicine)
  • Phillip E. Rodgers, MD, FAAHPM (University of Michigan, Ann Arbor)
  • Stacie Sinclair, MPP, LSWA (Center to Advance Palliative Care) 
This no charge webinar will provide an overview of the new payment rules and potential opportunities created under the Medicare Access and CHIP Reauthorization Act (MACRA), along with practical guidance for palliative care providers to implement these changes. Presenters will also solicit participants' questions, concerns, and suggestions to inform formal responses to Centers for Medicare and Medicaid Services (CMS), which are due June 27.

For readers who may not be familiar with CHIP, per the CMS website: "The Children's Health Insurance Program (CHIP) provides health coverage to eligible children, through both Medicaid and separate CHIP programs.  CHIP is administered by states, according to federal requirements.  The program is funded jointly by states and the federal government.
Please contact Stacie Sinclair (stacie.sinclair@mssm.edu) with any questions.

Wednesday, June 8, 2016

The goals of this webinar are to:
1.       Educate all in the field around Medicare Access and CHIP Reauthorization Act (MACRA), Merit Based Incentive Payment Systems (MIPS), and Advanced Payments Models (APMs);
2.       Identify possible opportunities and pitfalls for palliative care; and
3.       Solicit comments and questions from our audience.

Speakers are:

  • Joe Rotella, MD, MBA, HMDC, FAAHPM (American Academy of Hospice and Palliative Medicine)
  • Phillip E. Rodgers, MD, FAAHPM (University of Michigan, Ann Arbor)
  • Stacie Sinclair, MPP, LSWA (Center to Advance Palliative Care)
  • George Handzo, BCC, CSSBB (HealthCare Chaplaincy Network)

This no charge webinar will provide an overview of the new payment rules and potential opportunities created under the Medicare Access and CHIP Reauthorization Act (MACRA), along with practical guidance for palliative care providers to implement these changes. Presenters will also solicit participants’ questions, concerns, and suggestions to inform formal responses to Centers for Medicare and Medicaid Services (CMS), which are due June 27.

For readers who may not be familiar with CHIP, per the CMS website: “The Children’s Health Insurance Program (CHIP) provides health coverage to eligible children, through both Medicaid and separate CHIP programs. CHIP is administered by states, according to federal requirements. The program is funded jointly by states and the federal government.

Register for this free webinar here.

Please contact Stacie Sinclair (stacie.sinclair@mssm.edu) with any questions.


Spiritual Care Association

Twelve years ago under the initiative and financial support of HealthCare Chaplaincy Network (HCCN) the Common Standards for Professional Chaplaincy were adopted by six chaplaincy and pastoral counseling membership associations in North America. Throughout the last decade there has been a significant amount of new evidence in the area of spiritual care and the profession of chaplaincy as well as significant changes in the delivery of health care. In view of these changes, HCCN once again took the initiative and gathered an international panel to review the competencies for professional health care chaplaincy taking into consideration developments which would impact these competencies. The result was the HCCN product entitled "Scope of Practice."

The content of this first ever evidence-based Scope of Practice for health care chaplaincy addresses the needs of today's health care environment which demand demonstrated outcomes and value. In addition this document, which is mirrored in other professions, enables professional chaplains to be recognized as qualified in their field as physicians, nurses, social workers, and others are in theirs. The "Scope of Practice" document, which incorporates standards from the 2004 Common Standards and from other models from around the globe, now defines The New Standards for Professional Chaplaincy. It aligns with the evidence-based Quality Indicators document, entitled "What Is Quality Spiritual Care in Health Care and How Do You Measure It," also developed by an international multidisciplinary panel of experts.

Both documents were disseminated earlier this year and have received widespread approval in the professional chaplaincy and spiritual care world. In addition, HCCN has encouraged and requests ongoing comment to incorporate any findings or considerations so as to ensure that these documents continue to reflect the best perspective for our field and for our profession. HCCN and The Spiritual Care Association offer both documents to all chaplains and chaplaincy associations to adopt, test, and continue to contribute to them. I welcome your comments and questions at info@SpiritualCareAssociation.org.

Peace & Blessings!


Eric Hall Signature

Rev. Eric J. Hall
President & CEO
HealthCare Chaplaincy Network and Spiritual Care Association


Patient Centered


April 2016 Issue No. 9

We hope that you find this complimentary monthly e-newsletter informative. Below are short summaries of each selected item with links to the entire pieces. Please feel free to send any questions or comments to comm@healthcarechaplaincy.org.



Rev. Eric J. Hall
President & CEO
HealthCare Chaplaincy Network & Spiritual Care Association

Patient Engagement

Engage patients to improve outcomes and reduce risks (KevinMD.com)

Active patient engagement is a quality measure of the Institute for Healthcare Improvement’s Triple Aim Initiative, a framework targeted at optimizing health systems “to improve care, improve population health, and reduce costs per capita.”

Read more: http://www.kevinmd.com/blog/2016/03/engage-patients-to-improve-outcomes-and-reduce-risks.html)

Hearing the Voice of the Patient (The Rev. George Handzo, BCC, CSSBB)

These days, it is almost scandalous to suggest that patients and their family caregivers should not be consulted and included in deciding on their care. Many of us are advocating models in which the patient actually sits in on the team's care planning rather than the team having discussions without the patient and then bringing the patient into the conversation to "discuss" the plan the team has already decided on.

However, as with most conditions in life, this one comes with some consequences that many didn't anticipate and some providers don't necessarily like.

Read more: http://hccnproviders.blogspot.com/2016/04/hearing-voice-of-patient.html


Palliative Care

Stigma keeps some cancer patients from getting palliative care (Reuters)

Some cancer patients may turn down care that could ease their pain and improve their quality of life because they think this type of “palliative” treatment amounts to giving up and simply waiting to die, a small Canadian study suggests.

Even though the World Health Organization recommends early palliative care for patients living with any serious illness, negative attitudes among patients and family caregivers often lead them to reject this option, researchers note in the Canadian Medical Association Journal.

Read more: http://www.reuters.com/article/us-health-cancer-palliative-stigma-idUSKCN0XF27J


Collaborative Care Intervention Improves Side Effects, Quality of Life for Patients and Caregivers (Oncology Nurse Advisor)

Active screening and symptom management in patients with cancer reduces depression, pain, and fatigue, and improves quality of life for patients and their family caregivers, a study published in the journal Cancer has shown.1

Because effective palliative care can improve outcomes for patients and ease the burden of care for their caregivers, researchers sought to determine the efficacy of a collaborative care intervention on depression, pain, and fatigue and quality of life for patients with cancer and their family caregiver.

Read more: http://www.oncologynurseadvisor.com/daily-oncology-news/collaborative-care-intervention-side-effect-quality-life-management/article/485011/


Spiritual/Chaplaincy Care

How chaplains are a valuable part of the health care team (KevinMD.com)

At a time when perhaps health care chaplains can be more of an asset than ever, there are several issues that have been inhibiting the profession. They are issues that cannot be ignored, not just within the discipline of chaplaincy but by health care leaders….

As the chaplaincy profession continues to evolve, there are several actions health care leaders can — and should — do now.

  • The first step is determining whether your organization has a chaplain(s) on the team. If not, an essential element of whole-person care is missing.
  • Next, ensure that the chaplain has the education, training and credentialing that is recognized within the profession, and advocate for competency for best patient outcomes.
  • Encourage other members of the interdisciplinary team to obtain basic knowledge of spiritual care to incorporate into their scope of practice and to facilitate interactions with and referrals to chaplains.
  • Read the quality indicators and scope of practice documents, and, in collaboration with your organization’s chaplaincy department, commit to the suggested quality indicators and competencies.
  • Make your voice known that you value chaplains as members of the interdisciplinary team, and support the move within the profession to explore new avenues of training, standardization of practice, and commitment to research and quality.

Read more: http://www.kevinmd.com/blog/2016/03/chaplains-valuable-part-health-care-team.html

Third Annual Caring for the Human Spirit® Conference Is Best Yet. Health Care Professionals Who Provide Spiritual Care Were Energized by the Knowledge Sharing and Networking (plainviews.healthcarechaplaincy.org)

“I’ve been a chaplain for 16 years, and this was the best conference I’ve attended,” said one participant.

More than 300 in-person attendees and thousands via webcast from 13 countries - chaplains, physicians, nurses, social workers, researchers, educators and others - participated in the third annual Caring for the Human Spirit® conference hosted by HealthCare Chaplaincy Network in San Diego, Calif., April 11-13, 2016.

The conference included six major addresses, 30+ workshops on a wide variety of topics, poster sessions, and considerable opportunities for small group and one-on-one dialogue.

At the conference’s conclusion Denise LaChance, Director of Mission Integration & Spiritual Care for a California medical center said: “ The excellent plenary talks and workshops I attended and several in-depth conversations each addressed something specific we are working on at our hospital, from the big picture perspective of the importance of both research and story in communicating the significance of spiritual care to our health care colleagues to specific new screening tools we may be able to use to screen for spiritual needs. I am very excited about the future of chaplaincy and my place in it after this conference.”

Beth Delaney, a Nurse Practitioner and Assistant Professor of Nursing in Ohio said: “As a nurse practitioner who cares for cancer patients, my nurse research partner and I found attending the Caring for the Human Spirit conference provided a forum for ‘like minded’ health care individuals to form a community of inquiry, where learning and supporting one another encourage all of us to continually strive to improve the care for one of the most unique characteristics of all humans...the spirit.”

Read more: http://plainviews.healthcarechaplaincy.org/articles/Third_Annual_Caring_for_the_Human_Spirit_Conference_is_Best_Yet

New Spiritual Care Association Formed to Advance Chaplaincy Profession and Provision of Spiritual Care by Other Disciplines…Meets Rising Demand for Spiritual Aspect of Whole Person-Care in Today’s Health System

A new interdisciplinary professional organization focusing on spiritual care, the Spiritual Care Association (SCA), was announced on April 11th. It has been established with the goals of providing robust education and career paths in spiritual care in health care, raising chaplaincy to a more standardized and visible profession, and, ultimately, helping more people in need of spiritual support. “It’s time to make spiritual care a priority. This forward-looking model modernizes the profession and maximizes the potential of spiritual care in whole-person care,” said Rev. Eric J. Hall, SCA’s president and CEO.

Watch or read announcement, and download informational brochure here: http://www.healthcarechaplaincy.org/sca.html
Find SCA website here: http://spiritualcareassociation.org/home.html
Send questions or comments to info@SpiritualCareAssociation.org

The Elder Spirituality Project (www.spiritualityandpractice.com)

Elder Spirituality is a focus whose time has come. Traditionally in the world's religions, the last stage of life is seen as a time for intensified spiritual work as well as for passing on wisdom to other generations. In the United States, a Baby Boomer turns 65 every 7 seconds, and people are living longer in other parts of the world as well. Here at Spirituality & Practice, elders are a growing and important group using our resources for spiritual journeys.

Go to site which includes curated content here (http://www.spiritualityandpractice.com/projects/elder-spirituality/overview)

Is High-Quality Spiritual Care in Your Future? (CKN – Cancer Knowledge Network: cancerkn.com)

The value of spiritual care as a contributor to health and healing is increasingly being recognized. Yet, many more inpatients desire conversations about religion/spirituality than actually have them. Some may not know to request a chaplaincy visit or may not be offered one. While chaplains are increasingly engaged as members of palliative care teams, there are health care settings that lack chaplains, don’t fully integrate them into health care teams, or don’t have enough to see all those in need.

Now, many more of these conversations may take place, thanks to some new developments in the field of professional chaplaincy. Two panels of top multidisciplinary experts, convened by HealthCare Chaplaincy Network, have developed evidence-based indicators for determining the quality of spiritual care and evidence-based competencies for chaplains. These tools provide a framework for providing spiritual care and how to measure its outcomes—a buzzword that goes a long way in today’s health care environment.

For individuals and their families, the message is loud and clear: quality spiritual care counts. With these new tools in hand, administrators and chaplaincy departments will be looking at not only if spiritual care is provided, but how it is provided.

Read more: https://cancerkn.com/is-high-quality-spiritual-care-in-your-future/

The Gift of Presence, the Perils of Advice (www.onbeing.org)

Parker J. Palmer - Quaker elder, educator, activist, and founder of the Center for Courage & Renewal – writes:

Advice-giving comes naturally to our species, and is mostly done with good intent. But in my experience, the driver behind a lot of advice has as much to do with self-interest as interest in the other’s needs — and some advice can end up doing more harm than good…
Here’s the deal. The human soul doesn’t want to be advised or fixed or saved. It simply wants to be witnessed — to be seen, heard and companioned exactly as it is. When we make that kind of deep bow to the soul of a suffering person, our respect reinforces the soul’s healing resources, the only resources that can help the sufferer make it through.

Read more: http://www.onbeing.org/blog/parker-palmer-the-gift-of-presence-the-perils-of-advice/8628