Charting Spiritual Care: Ethical Perspectives

The introduction of electronic health records (EHRs) into clinical practice appears to be irreversible. Where EHRs are used, chaplains have cooperated willingly with this way of reporting and sharing information with other members of the care team. They will have to, as a result, adapt their own note-taking practices to ensure effective, relevant and meaningful communication as part of the joint decision-making process. Although the specialized literature has addressed some of the “classic” ethical issues raised by EHRs, in particular those in connection with confidentiality and access, other questions, no less crucial, have received less attention and are addressed here. They include questions about the recognition of all players in the care relationship (both patients and caregivers) as subjects, and the communication of “non-generic” information about emotions, values, life history, etc. The fact that chaplains contribute to EHRs is both a sign of and a vector for recognition of their work within healthcare institutions – yet a recognition that could involve a price to pay for chaplains and patients.

Charting Spiritual Care: Psychiatric and Psychotherapeutic Aspects

Proactively addressing religious and spiritual (r/s) issues has a strong intervention effect on patients, which is generally more important than the detailed content of spiritual screenings and assessments. When asked about r/s needs or problems, patients may feel bothered, surprised, annoyed, or, conversely, satisfied, supported, acknowledged in their coping efforts. Consequently, documentation should first and foremost reflect the patient’s reaction towards the clinician’s r/s intervention and to what extent the patient wishes this interaction to be shared within the healthcare team. In psychiatry and psychotherapy, patients’ spirituality is less pathologized than in former times and more and more accepted as a universal dimension of human experience, transcending individual religions. In mental health and in other medical fields, r/s may be part of the problem or part of the solution (K. Pargament), or both. Consequently, spiritual charting should not only differentiate pathological/negative and resilient/positive coping but consists of the patient’s r/s healthcare preferences and goals as well as the role he or she attributes to the health professional.

A Short History of Documenting Spiritual Care

The first chapter of this edited volume traces the history of documenting spiritual care. By referring to ancient and early modern practices, the relationship between spiritual (self-) care and various forms of documentation is outlined. The focus lies on developments in the twentieth and the twenty-first century, although the question of what constitutes an adequate practice of documenting healthcare chaplaincy is as old as the profession itself. The pioneers of Clinical Pastoral Education (CPE) – Richard Cabot, Anton Boisen, Russell L. Dicks, and others – developed distinctive forms of recording for different purposes. For example, procedures of documentation that are prepared for and helpful to the pastors themselves as “self-criticism,” “self-improvement,” or even “self-revelation” have been distinguished from documentation practices that are intra- or interprofessional. Regarding more recent developments in documentation, the introduction of electronic patient records (EMRs) was critical. We present a case study from Kenya to show how the issues discussed here are encountered in a non-Euro-American context.

Charting Spiritual Care in Digital Health: Analyses and Perspectives

This final contribution draws together the various lines of discussion. It outlines the main arguments as well as the points of convergence between transnational developments. Taking up the introductory chapters, the reasons for the rapid development of chaplaincy documentation in the last two decades are examined. The rise of charting spiritual care is understood as an aspect of the ongoing digitalization of society and healthcare. At least three further drivers are clearly identifiable: the emergence of a new paradigm of healthcare chaplaincy, the development of interprofessional spiritual care, and remarkable changes in Western societies concerning the role of religion and spirituality in public spaces. In current discussions about recording spiritual care in EMRs, there is a growing convergence on at least four points. First, used as a tool for planning, coordination, and self-evaluation, digital charting can benefit the work of chaplains. Second, it can also have undesired side effects. Third, any future healthcare chaplaincy will have to be a part of the evolving process of digital recording. Fourth, the ongoing change in healthcare and society forces chaplains to become clearer about its nature and role. In sum, the task of charting spiritual care into EMRs might be seen as a bureaucratic burden. However, with its questions of the “who,” the “what,” and the “how,” it touches the heart of chaplaincy as a spiritual profession in healthcare. The paper concludes with an outline of a possible future for the practice of charting spiritual care.

Spiritual Care Charting/Documenting/Recording/Assessment: A Perspective from the United Kingdom

This chapter explores how spiritual aspects of care are being documented within the UK with a specific focus on healthcare primarily in the nursing and chaplaincy professions. This has not been an easy undertaking given the lack of a standardised approach, the changing and challenging landscape of healthcare in the UK and the conflicting terminology used when trying to assess, capture and record encounters, interactions and conversations with patients and their carers about their spiritual needs. The authors draw upon their own research and informal enquiries with chaplains from across England, Scotland and Wales, demonstrating that there is a wide range and variation in practice. The authors conclude that there is no standardised means of assessing and documenting spiritual needs and care in the UK and that this is unlikely to change until the many complex challenges outlined are addressed both politically and professionally.

Introduction

The introduction provides a rationale for this edited volume and presents its main topics: the emerging digital age and the development of electronic medical records (EMRs), the question of spirituality and documentation in a larger interprofessional context, as well as the sustainability of future spiritual care. In the second part, it gives an overview of the state of research on charting spiritual care. Five different but intertwined areas of research are defined: (a) evoking conceptual questions or fundamental debates like that of confidentiality and (b) highlighting the connection between spiritual assessment and documentation procedures, as well as (c) recent models and (d) actual practices of documentation. Lastly (e), we take a look on the integration of patients’ views and perspectives into documentation processes. We conclude this introduction with a short survey of the following chapters.