Care From The Heart

'Unknown, Oct 2010' by Yunchung Lee via Flickr.com

The Association of Professional Chaplains (APC) sets written Standards of Practice by which hospital chaplains abide, as well as those in many other institutional settings.  Naturally, this includes Buddhist chaplains.  I wonder, however, if every chaplain who reads this document feels as though something is missing.  I’ve written about the danger of “professionalizing” chaplaincy before, and these standards seem to suffer from it.  Mostly, they suffer from a loss of heart, the living motivation that drives chaplains to care for others.

The Standards are helpful in knowing what our profession entails and how we should carry it out.  However, it is an extremely technical document and completely glosses over the main task of the chaplain: building relationships.  If one simply reads the standards by their titles, ‘Assessment,’ ‘Delivery,’ ‘Documentation,’ and so forth, they could easily refer to writing the engineering specifications for a new kind of catalytic converter.  Some imply human contact, such as ‘Teamwork’ and repeated use of the word ‘Care,’ while others, such as ‘Quality Improvement’ and ‘Research’ imply almost the opposite.

All in all, this document is a cognitive approach to understanding the work of the chaplain.  Meanwhile, the work chaplains do has an extremely broad affective, or emotional, dimension. This, most importantly, revolves around our ability to build a relationship with those to whom we offer care.  Moreover, I fear the technification of jargon used to describe the chaplain’s job may somehow mislead or diminish the chaplain’s true work.

In short, no matter how helpful and precise, I don’t like it.  The work of caring for hearts and souls loses something in translation to legalistic code.  For example, the first standard states:

STANDARD 1: ASSESSMENT

Assessment: The chaplain gathers and evaluates relevant data pertinent to the patient’s situation and/or bio-psycho-social-spiritual/religious health.

INTERPRETATION

Assessment is a fundamental process of chaplaincy practice. Provision of effective care requires that chaplains assess and reassess patient needs and modify plans of care accordingly. A chaplaincy assessment in health care settings involves relevant biomedical, psycho-social, and spiritual/religious factors, including the needs, hopes, and resources of the individual patient and/or family.

A comprehensive chaplaincy assessment process includes:

• Gathering and evaluating information about the spiritual/religious, emotional and social needs, hopes, and resources of the patient or the situation
• Prioritizing care for those whose needs appear to outweigh their resources

MEASUREMENT CRITERIA

• Gathers data in an intentional, systematic, and ongoing process with the assent of the patient.
• Involves the patient, family, other health care providers, and the patient’s local spiritual/religious community, as appropriate, in the assessment.
• Prioritizes data collection activities based on the patient’s condition or anticipated needs of the patient or situation.
• Uses appropriate assessment techniques and instruments in collecting pertinent data.
• Synthesizes and evaluates available data, information, and knowledge relevant to the situation to identify patterns and variances.
• Documents relevant data and plans of care in a retrievable format accessible to the health care delivery team.

EXAMPLES

• Basic: Demonstrates familiarity with one accepted model for spiritual/religious assessment and makes use of that model in his/her chaplaincy practice as appropriate.
• Intermediate: Demonstrates familiarity with several published models for spiritual/religious assessment and is able to select an appropriate model for specific cases within his/her chaplaincy practice.
• Advanced: Demonstrates familiarity with several published models for spiritual/religious assessment and is able to teach others in their use.

We do not “gather and evaluated relevant data pertinent to the patient’s situation and/or bio-psycho-social-spiritual/religious health.”  Rather, we learn about the patient by listening to their troubles.  By listening, I don’t mean with just our ears either, but with every sensory perception, including our mind and heart.  We discover the person, their cares, their strengths, their fears.  People are not “data.”

Relationships figure more prominently in the complete explanation of Standard 1.  But should we really have to go to such great lengths to explain what is mean by “gather and evaluate relevant data?”  In this explanation, “data” is used almost as often as “patient.” This is not meaningless semantics.  There are no meaningless words.

“We are what we think / All that we are arises with our thoughts,” According to the Dhammapada, verse one.

Let us do a thought experiment.  What if we go into a room and try to enact these Standards of Practice thinking we need to begin by “gathering data?”  Now, what if we go into a room thinking we need to “discover this person?”  How does that alter the nature of our mind and heart?

While the contents of the Standards of Practice are helpful and obviously the result of long, thoughtful, and reasoned discussion, I strongly believe they need to be rewritten to reflect the reality of a chaplain’s work.  We are not lawyers or technocrats or “data gatherers.”  We are spiritual caregivers.  We should have the conviction to describe our work in the language of spiritual care.  I believe doing so will better prepare and guide chaplains in carrying out that work and better inform the public as to the nature, and importance, of what chaplains do.