Chaplains’ perspectives on standardizing spiritual assessments.

Abstract

Chaplains are an integral part of mental health treatment within the Veterans Health Administration (VHA) and over the past decade, efforts have been made to integrate chaplain services into behavioral health treatment. One unique duty of chaplains is to conduct spiritual assessments, which are characterized as collaborative discussions with veterans to understand their overall religious and belief system, identify spiritual injuries, and how to integrate one’s spiritual values into medical care. Although spiritual assessments in Veterans Affairs Medical Centers have evolved throughout the years to adopt a more structured approach, spiritual assessments can vary depending on site, clinical setting, and medical center. The present study sought to examine chaplains’ perspectives on standardizing spiritual assessments and incorporating empirically validated measures into the assessments. Thematic analysis was conducted on two focus groups of chaplains from a large VHA medical center. Overall, chaplains appeared interested in standardizing spiritual assessments, with an expressed desire to maintain their current conversational format.

Single-Item Instruments to Measure Aspects of Whole Person Care for an Inpatient Palliative Care Chaplain's Clinical Note: An Examination of Tools

“…Person-centered outcomes are evident through a palliative chaplain's use of singleitem measures to seek information about patient well-being (QoL) as well as the patient's perceived quality of care. Additionally, chaplains can weave these singleitem questions into reflective conversation (Boska et al, 2022) with the benefit of time (McSherry et al, 2016) to invite narratives to be shared as patients explore meanings and identify values, preferences, and needs (Miles & Asbridge, 2017). Because a number implies a narrative (Jurecic, 2012), chaplains are poised to process the meaning of a patient's QoL rating from 1 (dissatisfied) to 7 (satisfied) (Conrad et al, 2017).…”

“…For those patients discerned to be eligible for completing a one-item measure that could be integrated into conversation (Boska et al, 2022) and patient storytelling (Puchalski et al, 2009), the chaplain would still need to consider patient vulnerability (Bruera, 1994) and the elicitation of anxiety or distress (Richards & Schwartz, 2002). Another ethical consideration involves how the chaplain responsibly documents the results of the one-item measures in the electronic health record (EHR).…”

“…Therefore, it is important to document actionable content for collaboration that is not too lengthy (Galchutt et al, 2023). Recognizing chaplains prefer to keep their care encounters free of structured interview assessments (Boska et al, 2022), consideration could be given to integrating brief evidence-based measures that remain conversational, are within their clinical scope of care, and are actionable for team collaboration. Few tools that meet these goals have been developed and reviewed.…”

Who owns spiritual care, and why does it matter?

“…This outline is followed by a review of examples of effective collaboration, particularly in federal settings, as well as a useful discussion of future directions. Boska et al (2023) recognize the need for collaboration at a foundational level. Seeing the opportunity to have chaplains identify veterans who are managing moral injury syndrome and get them appropriate help, this research team did not just ask chaplains to collaborate; they included a chaplain on the investigative team and started with focus groups to learn about the clinical settings in which chaplains administer spiritual assessments.…”