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Evaluating Chaplain Chart Notes

Webinar Three in a Four part Series July-August, 2018

Gordon J. Hilsman, D. Min.

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Spiritual care notes are:

Human to Human (Intersubjective and direct) Earthy (vs. tidy, neat, proper, correct) Stark, Striking, Interesting, colorful, punchy, pithy Quote Illustrated (for concreteness) Intuitive (blended with good sense)

Concise

Mostly devoid of self reference

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Chart Evaluation Exercise

Example # 1: 27 y/o, second language

RoseMary daughter mid-50s appeared anxious,

hopeful and was in tears right before her father’s

procedure. She requested prayer before he went in,

after the prayer was said it seemed to bring her and her father comfort while waiting for the procedure to be

ver she was notified that her father coded. We walked

down together and received the news that they were

working. She was distraught to receive the news and in

tears weeping loudly her sister was notified via phone and her brother was shortly notified as well. Her father was taken to MICU where her family arrived. She expressed great faith in “God and in his plan, and his will.”

Example 1#: Bullet Points

Daughter says she was looking forward to celebrating

his 80th birthday next month

The chaplain extended the ministry of his presence

and support to RoseMary, by listening compassionately and waiting ‘till the family arrived

The daughter expressed appreciation for the

chaplain’s visit

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Consultative Comments

The note is functional. It works. Perfect English is

not to be pursued with any vigor.

Learning to be concise in charting takes effort, time

and persistence.

The note might have made it explicit that the

daughter was aware that her father could die after the surgery. (Which he did.)

Arenas here – Losses and “Childing”— give rise to

spiritual needs of immanent grief and fear. They are clearly implied but not made explicit.

1. Careful Listening
2. Empathic Reflecting
3. Gentle Query
4. Supportive

Validating

5. Insightful

Interpreting

A S S E S S I N G

1. Need To Talk
2. Minimizing Fears and Anxiety
3. Assuaging Resentment and Hostility
4. Healing Sadness, Discouragement, Despair
5. Addressing Deep Hurt
6. Empowerment
7. Current or Recent Loss
8. Prior Loss
9. Dying
10. Life Adjustment
11. Estrangement

Establishing Rapport

12. Religious Support
13. Spiritual Validation
14. Spiritual Counseling
15. Self-Forgiveness
16. Instructing
17. Ethics Confusion
18. Addiction/Mental Illness Concerns
19. Advocacy
20. Family Conflict
21. Love Life Pain

Axis 1: EMOTIONAL SUPPORT NEEDS Axis 2: MAJOR LOSS NEEDS Axis 3: RELIGIOUS/SPIRITUAL SUPPORT NEEDS Axis 4: REFERRAL NEEDS

Spiritual Needs Framework

Example #2, a 32 y/o Catholic Seminarian, former military, experienced med. Tech.

Patient is a 48 y/o male experiencing abdominal

pain. Presents as very alert, polite, and devout

member of his own faith, with a great respect for individuals and members of other spiritual

traditions. Patient vocalized having a strong family,

and garners a strong sense of purpose in his religious

devotion. Healthy spiritual state, and no follow-up

planned at this time.

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Consultative Comments

Reassuring note about a positive attitude towards

treatment and hospitalization.

Seems rather superficially positive. No spiritual

needs identified. Maybe so!

Bullet points?

Presenting the Note Orally

It helps if the charting person presents the note

rally when possible. That brings to the surface

elements left out, by neglect or ethical protocol. For example the following patient had three small children, a new helpful boyfriend after extricating herself from the abusive father of her children; a history of abuse by her father; one of her children had recently been “touched” at school which was reported to state social services; and she had gone to a priest for help who leaked confidential material to the woman’s sister. Some but not all of that could be communicated to the nursing staff and physician.

Example #3: 60 y/o first unit student, married spiritual director,

Ms. F is a 28 y/o mother, trying to wait for a few more weeks in

the hospital for the health of her unborn baby. She is having a hard time not being at home with her children. Ms. F also has

ther medical problems, which has complicated her health with

the baby.

The patient spoke about her children, and her relationship

with her parents and siblings. It is a hard situation. She talked for about 90 minutes.

Ms. F. spoke of faith and her relationship with God. She said

she was a lonely person. She said she did talk with God. He was the only one she could talk to.

I prayed with her and gave my card with my pager number. I

told her I’d come back to visit with her and I or anyone in the Chaplain’s office would come if she requested us. She though she’d be in the hospital for another 3 weeks.

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Consultative Comments and Questions

First sentence could mention the woman spoke to

her for 90 minutes, indicating a strong need to talk right upfront, as the lede.

A bit wordy. Would combining sentences make it

more readable?

Does the patient have other children? Is she being

mis-treated by family member?

Re-written note effort

This is a 27 year old woman beleaguered by several painful interpersonal and social problems who spoke to me haltingly for 90 minutes about them. She has three children, the care of whom worries her while she is hospitalized. She has a new supportive boyfriend who she relies on to a degree, but feels quite isolated, saying the only one she talks to is God. She talks

f a history of mistreatment for which I made contacts and
referrals. My pager # is ______.
Patient expressed gratefulness for the open talk and the

prescriptive prayer we said together

I promised to follow up with patient and assured her of

spiritual care’s availability

Patient says she expects to be here for another three weeks.

The Future of Narrative Charting

Is a humanistic approach the lead point of a health

care revolution that humanizes health care?

Will IDT members reading chaplain notes

comprehensively (because they are helpful to their professional practice) increase demand for chaplains as a vital discipline that is only beginning to insert itself into interdisciplinary care?

Are nurses in general ready to invest in a human to

human approach to spiritual care, that matches their direct approach to conversing about patients among themselves?

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