Global Conversation Partners: What can we learn from our European colleagues about chaplain documentation?
M. Jeanne Wirpsa Program Manager & Clinical Ethicist, Medical Ethicist, Medical Ethics, Research Chaplain, Spiritual Care and Education Northwestern Memorial Hospital
Anyone who has travelled to an unfamiliar part of the world can attest: Physical distance from home and exposure to different sights and customs offer a unique vantage point from which to reflect on our own perspective and practices. The recently published White Paper, “Charting by Chaplains in Healthcare” (Vandenhoeck et al., 2022). invites healthcare chaplains in the United States to claim the progress we’ve made in this area but also to question our adoption of models for documentation that have little to no grounding in research.
The White Paper is an ambitious first step by the European Research Institute for Chaplains in Healthcare (ERICH) to build consensus in a core area of chaplaincy care where none previously existed. It builds on work by Swiss colleagues (Peng-Keller, et al., 2020) in which they describe variations in practice between countries, address concerns about confidentiality, and suggest next steps for research. As the authors disclose, the White Paper is intended as a precursor to research on patient views of chaplain charting, research necessitated in no small part by the international “open notes” movement and prompted by the development of patient-centered outcome measurements for spiritual care (the Scottish PROM).
The White Paper consists of seven chapters that cover core issues in documentation: the value of charting for patient care and chaplain professionalism, recommendations on best practices for language, protecting confidentiality of patient, preferences for structure and format of documentation, and next steps in research. For chaplains in the United States who are not involved in research on chaplain documentation or in efforts to standardize electronic medical record templates, these chapters may be useful as they provide a clear, comprehensive picture of developments in this area to date. The transparency in this document about chaplaincy resistance to charting and institutional barriers to inclusion not only is refreshing but may resonate with select groups of chaplains practicing in non-academic medical centers or newly established departments of spiritual care.
For the most part, our European colleagues are just beginning to wrestle with issues related to documentation to which US chaplains have given considerable thought, with one important exception: Patient-centered approaches to care and documentation. Scottish chaplains, under the direction of Austyn Snowden, developed and validated the PROM (Patient Reported Outcome Measures) for Spiritual Care (Snowden & Telfer, 2017; Tan et al., 2020). Attempts to integrate the PROM for Spiritual Care in documentation is a novel initiative worth replicating in the US context. Building upon that work, ERICH’s next step is to conduct research into what patients themselves find useful in chaplain documentation – especially given that many can now access these notes in real time. These research findings will be of great interest to chaplain leaders involved in design of the electronic medical record in the US.
The purpose of a White Paper is to provide not only a summary of the current state of affairs on an unresolved topic of debate but also to advocate for best practices. To be fair, the authors acknowledge the lack of research to support many of their recommendations. Yet, they promote several “best practices” that, at least in the United States, are currently challenged by emerging research. For example, the White Paper adopts the 5-part model – Reason for Visit, Assessment, Intervention, Outcome and Plan of Care – as the standard, accepted approach. While many chaplains find this a helpful framework for approaching the care of a patient, and it has been widely adopted as a structure in EPIC and other electronic medical record platforms, there is no evidence to support it as a preferred approach for documenting our care in the medical record. Limited research with palliative care providers, for example, suggests a thematic approach to documentation might be more helpful to non-chaplain colleagues (Galchutt & Connolly, 2020) .
We know little to nothing about what our non-chaplain colleagues would find helpful in chaplaincy notes, let alone what format they would be most likely to read (Choi et al., 2019). That our documentation in the medical record improves the care of patients is another claim that remains unsubstantiated in both the US and European contexts. Chaplains certainly hope the time spent “telling the patient’s story” (Tracey et al., 2021) and lifting up religious or emotional factors that impact the patient’s coping or approach to decision making (Johnson et al., 2016) are not a waste of our time. However, we cannot (yet) connect the dots between what we enter into a person’s chart and the care provided by the medical team. Herein, as our European colleagues concur, lies another opportunity for chaplains to join together in research to promote evidence-based practice.
Chaplains and spiritual care department leaders hoping to ground their practice and EMR design in evidence may be excited to learn about several research projects under development here in the US:
- What do non-chaplain clinicians find useful in chaplaincy documentation? A National Survey of Healthcare Providers in the United States – Karen Terry, Chaplain, Mount Sinai, Principal Investigator.
- Interprofessional Preferences for Inpatient Palliative Chaplain Spiritual Assessment Documentation – Paul Galchutt, Research Staff Chaplain, M Health Fairview, University of Minnesota Medical Center, Principal Investigator. This is an exploratory research project designed to identify the format and content preferences of non-chaplain inpatient palliative care team members concerning chaplaincy documentation. Using case vignettes, experts associated with published spiritual assessment models (Spiritual AIM – Allison Kestenbaum; PC-7 – Dirk Labuschagne; Outcome Oriented Chaplaincy – Brent Peery) created documentation for the focus group discussions. This project involves focus groups from four palliative care teams. The project is supported by a grant from the Strategic Fund of the Association of Professional Chaplains.
If you are currently conducting research in this area, please reach out to me at email@example.com or through Transforming Chaplaincy, Research Network via Mighty Network. Finally, be on the lookout for an invitation to assist in distributing KarenTerry’s national survey to your healthcare colleagues.
Choi, P. J., Curlin, F. A., & Cox, C. E. (2019). Addressing religion and spirituality in the intensive care unit: A survey of clinicians. Palliative & supportive care, 17(2), 159-164.
Galchutt, P., & Connolly, J. (2020). Palliative chaplain spiritual assessment progress notes. In S. Peng-Keller & D. Neuhold, D. (Eds.) Charting spiritual care: The emerging role of chaplaincy records in global healthcare, p 181-198. Zurich: Springer Nature.
Johnson, R., Wirpsa, M. J., Boyken, L., Sakumoto, M., Handzo, G., Kho, A., & Emanuel, L. (2016). Communicating chaplains’ care: Narrative documentation in a neuroscience-spine intensive care unit. Journal of Health Care Chaplaincy, 22(4), 133-150.
Peng-Keller, S., & Neuhold, D. (Eds.) (2020). Charting spiritual care: The emerging role of chaplaincy records in global healthcare. Zurich: Springer Nature. https://doi.org/10.1007/978-3-030-47070-8
Snowden A, & Telfer I. (2017). Patient Reported Outcome Measure of spiritual care as delivered by chaplains. Journal of Health Care Chaplaincy. Oct-Dec;23(4):131-155. doi:10.1080/08854726.2017.1279935.
Tan H, Rumbold B, Gardner F, et al., (2020). Understanding the outcomes of spiritual care as experienced by patients. Journal of Health Care Chaplaincy. July 26:1-15. doi:10.1080/08854726.2020.1793095. Epub ahead of print.
Tracey E, Crowe T, Wilson J, Ponnala J, Rodriguez-Hobbs J, Teague P. (2021). An introduction to a novel intervention, “This is My Story”, to support interdisciplinary medical teams delivering care to non-communicative patients. Journal of Religion and Health 60(5):3282-3290. doi: 10.1007/s10943-021-01379-3.
Vandenhoeck A, Verhoef J, Nuzum D, et al. (2022). Charting by chaplains in healthcare: white paper of the european research institute for chaplains in healthcare. Health and Social Care Chaplaincy, 10(1) https://doi.org/10.1558/hscc.20583. The White Paper is also available on the ERICH website at