Raising the Standard?

1. Raising the Standard? The development of palliative care Chaplaincy in Scotland

3. The Embarrassing Guest The unwelcome guest

4. A decade of development • Explanation of hospice in Scotland • It’s a building not a programme! • Mainly voluntary • 1998 • 14 hospices • 2 full time chaplains. 1 part time and most others used parish clergy • Some hospices had no worship/quiet space • Spiritual Care=Religious Care • Chaplains view • spiritual care can’t be put into words, audited or measured

5. A decade of development • 2008 • 15 hospices • 13 full time chaplains • All have worship/prayer space • Chaplains are part of the multi-disciplinary team • Chaplaincy has standards and competencies which can be measured and audited

6. Developing chaplaincy •Distinguished spiritual care and religious care • HDL 2002 •Engaged with the process of standards • Developing of national chaplaincy organisations • AHPCC, SACH, TDU (NES) • Took an active part in working groups • Professional study and research in palliative care

7. Government Standards • Clinical standards for specialist palliative care • Integrate spiritual and religious care into palliative care • Chaplaincy a core member of MDT • All hospice should have a worship/prayer space • All chaplains should be a member of their specialist interest group (AHPCC) • Defined spiritual interventions

8. Spiritual Interventions • exploring the individual’s sense of meaning and purpose in life; • exploring attitudes, beliefs, ideas, values and concerns around life and death issues; • affirming life and worth by encouraging reminiscing of the past; • exploring the individual’s hopes and fears regarding the present and future for themselves and their families/carers; • exploring the ‘WHY' questions in relation to life, death and suffering.

9. Professional Standards (AHPCC 2006) • Structure for palliative care chaplaincy • Access to chaplaincy services • Spiritual and religious care • Multidisciplinary team working • Staff support • Education and training • Resources • Chaplaincy to the unit

11. Individual Competencies Marie Curie Cancer Care 2003 •Spiritual and Religious Care Competencies for Specialist Palliative Care • All health care staff have the potential to provide spiritual care • Chaplaincy has a particular role and expertise in spiritual and religious care •A progressive 4 level model • Identifies skills different staff should have • Raises awareness to personal strengths and limitations • Identifies personal education and training needs • Provides a referral path to specialist expertise -chaplaincy

12. Competency levels • Level 1: casual contact • This level seeks to ensure that all staff and volunteers understand that all people have spiritual needs and distinguishes between spiritual and religious needs. It seeks to encourage basic skills of awareness, relationships and communication, and an ability to refer concerns to members of the multidisciplinary team. • Level 2: duties require regular contact • This level builds on level 1 with an increased awareness of spiritual and religious needs and how they may be identified and met. In addition to increased communication skills, identification and referral of difficult needs should be achievable

13. Competency levels • Level 3: multidisciplinary team • This level opens up the assessment of spiritual and religious need, developing plans for care and recognising complex spiritual, religious and ethical issues. This level also introduces confidentiality and the recording of sensitive and personal patient information. • Level 4: primary responsibility • Staff working at level 4 are expected to be able to manage and facilitate complex spiritual and religious needs in patients, families/carers, staff and volunteers. In particular they will deal with the existential and practical needs arising from the impact on individuals and families from illness, life, dying and death.

14. Key factors in development • •Engaged with the process at national level • Working group on clinical standards •Used specialist knowledge to create professional chaplaincy standards • You can audit spiritual and religious care •Worked with other professions to create competencies for all health care professionals • All HCPs can provide spiritual care • Chaplaincy has a specialist expertise • A clear referral process based on competence

15. An example of good practice? •Scotland has influenced change in the UK • All 4 nations have different national guidelines forpalliative care • Chaplaincy standards are used by chaplains in all 4 countries • Competencies are used by chaplains across all 4 countries •Influencing change in Europe. • European Network of Health Care Chaplaincy • Statement on Chaplaincy Services in Palliative Care

16. Professionalism and Professionalisation • Professionalism is very important. To do a professional job chaplains require: • Integrity • Autonomy • Back-up • Support • Respect

17. Professionalism and Professionalisation • Professionalisation requires: • Body of knowledge • Code of ethics • Occupational organisation controlling profession • Substantive intellectual and practical training • Provision of specialist skill or service

18. References • AHPCC (2006) Standards for Hospice and Palliative Care Chaplaincy, 2nd Edition, Association of Hospice and Palliative Care Chaplains, United Kingdom. www.ahpcc.org.uk • ENHCC (2006) Statement on palliative Care in Europe. European Network of Health Care Chaplaincy. http://www.eurochaplains.org/lisbon06_palliative. doc MCCC (2003) Spiritual and Religious Care Competencies for Specialist Palliative Care, Marie Curie Cancer Care, London, United Kingdom, http://www.mariecurie.org.uk/forhealthcareprofessionals/ • NHS QIS (2002) Clinical Standards Specialist Palliative Care, NHS Quality Improvement Scotland, Edinburgh, Scotland http://www.nhshealthquality.org/nhsqis/files/SPC.pdf