By Cheryl Barnes-Neff, PhD, MDiv, RN
This is an excerpt of an article by this author posted on this site a while back but a powerful reminder.
Twenty years ago, I was hired as the Quality Manager for a local hospice. I believed in the concept after years of working as a nurse in hospitals, but I was new to hospice so I was eager to learn all I could about the regulations, and how an ideal hospice should run. I spent time reading charts, going on site visits with each discipline, and attending team meetings. It was wonderful to see the good work being done by each member of the hospice team: the hospice aides, the nurses, social workers, doctors, and especially the chaplains.
I was distressed, though, when I overheard some chaplains in the break room complaining that they felt the rest of the team didn’t appreciate or value their work. I talked with some of them about their feelings and asked other staff members about their impressions of the chaplain role. Some of the nurses said that while they felt the chaplains did help in certain situations, they didn’t really know why there needed to be a chaplain on each team – what did they do, exactly? In reading the charts more closely and attending team meetings with a focus on paying attention to the chaplain’s participation, I began to see what they meant!
The chaplains did a great job reporting and discussing the bereavement needs of family members after the patient’s death, but rarely contributed to the plan of care review portion of team meeting, and there was little of substance in their progress notes. In fact, the most common note was something along the lines of “said a prayer; patient grateful for my visit.” Not a very helpful contribution to the interdisciplinary approach to care.
I decided to give a documentation class for the chaplains to help them add detail to their notes, and to stress their participation in the Interdisciplinary Team (IDT). I used examples and had a list of good vs bad charting entries. They listened to my class politely, but when I asked if there were questions or concerns, they let me know that they couldn’t write any of the things I suggested. I was shocked! Why not? They explained that it was because of patient confidentiality. They thought of themselves as pastors and their patients as their parishioners; they felt duty bound to keep the confidences of their patients. There was little they could share with the rest of the team.
Going back to the drawing board was needed. As I researched this issue, I began to see what the confusion was. They weren’t thinking of themselves as part of a team, but as a kind of independent contractor. It is true that when a minister/ pastor/ priest is functioning in that role, there is a degree of “clergy-communicant” confidentiality. This confidentiality can be different in scope and degree depending on the specific religion or denomination, but it is something that chaplains who have had formal training in their faith tradition take very seriously.
However, when a religious leader becomes a professional chaplain, it is important to understand that the context of their conversations with their patients, family members, fellow staff, and even staff in the facilities where the patient resides are different from within their church, temple, or synagogue. When they are employed by their faith tradition, they are bound to the rules set forth by that tradition’s leadership as well as their conscience. When they are employed as a member of a hospice interdisciplinary team, the scope of their responsibilities changes.
Each member of the team is bound by the confidentiality rules of their organization, and as codified in the Health Insurance Portability and Accountability Act (HIPAA). In fact, I would venture to say that all hospices require all of their employees to sign a confidentiality agreement. All members of the team must communicate the patient’s assessment, goals of care, and the plan for achieving those goals. If the chaplain does not contribute to this process, the patient will miss out on valuable support that the whole team can provide.
Cheryl Barnes-Neff, PhD, MDiv, RN has been a nurse for over forty years, quality and regulatory compliance professional for thirty years, and in the hospice and palliative care field for twenty years. She is a frequent guest lecturer and speaker at professional conferences, and university schools of social work and nursing. She also works as a Buddhist chaplain, and frequently lectures about end of life issues for Buddhist patients, and cultural competency. Please visit http://www.barnesneff.com for more information.